Francia Piergiorgio, Seghieri Giuseppe, Gulisano Massimo, De Bellis Alessandra, Toni Sonia, Tedeschi Anna, Anichini Roberto
Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
Tuscany Regional Health Agency (ARS), Florence, Italy.
Diabetes Res Clin Pract. 2015 Jun;108(3):398-404. doi: 10.1016/j.diabres.2015.04.001. Epub 2015 Apr 15.
Evaluation of how ankle joint mobility (AJM) can be useful in the identification of patients with diabetes at risk of foot ulcer (FU).
Plantar and dorsal flexion of foot were evaluated using an inclinometer in 87 patients (54 type 2 and 33 type 1), and 35 healthy sex- and age-matched control subjects. Patients with diabetes were followed up for diagnosis of FU over the next 8 years and subsequently, patients were subdivided into: those without a history of FU (18 type 1 and 33 type 2), those who had a history of FU detected before baseline evaluation (14 type 2) and those who had history of first ulceration detected by the 8th year of the evaluation period (7 type 2).
Aging and diabetes caused a significant reduction in mobility of each of the movements investigated (p<0.001), whereas after adjusting for the confounding effect of age, diabetes specifically reduced plantar flexion (p<0.0001). AJM was significantly lower in those with history of previous FU compared to all the other groups (p<0.001). The first ulceration was detected in the same foot presenting lower AJM in 17 of the 22 subjects with diabetes with history of ulcer (77.27%).
Diabetes and aging reduce AJM although diabetes seems to reduce plantar flexion to a more specific extent. Reduced AJM is mostly associated with a previous history of FU. The evaluation of AJM is a valid and reliable ulcer risk scale that indicates which foot is at higher ulcer risk.
评估踝关节活动度（AJM）在识别有足部溃疡（FU）风险的糖尿病患者中的作用。
使用倾角仪对87例患者（54例2型糖尿病患者和33例1型糖尿病患者）以及35名年龄和性别匹配的健康对照者进行足背屈和跖屈评估。对糖尿病患者在接下来的8年中进行随访以诊断足部溃疡，随后，将患者分为：无足部溃疡病史者（18例1型糖尿病患者和33例2型糖尿病患者）、在基线评估前已检测出有足部溃疡病史者（14例2型糖尿病患者）以及在评估期第8年检测出首次发生溃疡者（7例2型糖尿病患者）。
衰老和糖尿病导致所研究的每个动作的活动度显著降低（p<0.001），而在调整年龄的混杂效应后，糖尿病尤其降低了跖屈（p<0.0001）。与所有其他组相比，有既往足部溃疡病史者的踝关节活动度显著更低（p<0.001）。在22例有溃疡病史的糖尿病患者中，有17例（77.27%）在踝关节活动度较低的同一足部检测出首次溃疡。
糖尿病和衰老会降低踝关节活动度，尽管糖尿病似乎在更特定的程度上降低跖屈。踝关节活动度降低主要与既往足部溃疡病史相关。踝关节活动度评估是一种有效且可靠的溃疡风险评估指标，可指示哪只脚有更高的溃疡风险。
