Sponer Pavel, Kucera Tomás, Brtková Jindra, Srot Jaromír
Department of Orthopaedic Surgery, Charles University in Prague, Faculty of Medicine in Hradec Králové, Czech Republic.
Acta Medica (Hradec Kralove). 2013;56(1):3-8. doi: 10.14712/18059694.2014.30.
Charcot foot neuropathic osteoarthropathy is a disorder affecting the soft tissues, joints, and bones of the foot and ankle. The disease is triggered in a susceptible individual through a process of uncontrolled inflammation leading to osteolysis, progressive fractures and articular malpositioning due to joint subluxations and dislocations. The progression of the chronic deformity with a collapsed plantar arch leads to plantar ulcerations because of increased pressure on the plantar osseous prominences and decreased plantar sensation. Subsequent deep soft tissue infection and osteomyelitis may result in amputation. The Charcot foot in diabetes represents an important diagnostic and therapeutic challenge in clinical practice. Conservative treatment remains the standard of the care for most patients with neuropathic disorder. Offloading the foot and immobilization based on individual merit are essential and are the most important recommendations in the active acute stage of the Charcot foot. Surgical realignment with stabilization is recommended in severe progressive neuropathic deformities consisting of a collapsed plantar arch with a rocker-bottom foot deformity.
夏科氏足神经性骨关节病是一种影响足踝部软组织、关节和骨骼的疾病。在易感个体中，该疾病通过不受控制的炎症过程引发，导致骨质溶解、渐进性骨折以及由于关节半脱位和脱位引起的关节位置异常。慢性畸形伴足底弓塌陷的进展会导致足底溃疡，这是因为足底骨性突起处压力增加以及足底感觉减退。随后的深部软组织感染和骨髓炎可能导致截肢。糖尿病患者的夏科氏足在临床实践中是一个重要的诊断和治疗挑战。保守治疗仍然是大多数神经性疾病患者的标准治疗方法。根据个体情况减轻足部负荷并进行固定至关重要，也是夏科氏足急性期最重要的建议。对于严重的进行性神经性畸形，包括伴有摇椅底足畸形的足底弓塌陷，建议进行手术复位并稳定固定。
