Sims D S, Cavanagh P R, Ulbrecht J S
Center for Locomotion Studies, Pennsylvania State University, University Park 16802.
Phys Ther. 1988 Dec;68(12):1887-902. doi: 10.1093/ptj/68.12.1887.
The most frequently reported diabetic foot complication is plantar ulceration. Neuropathic fractures occur less often than plantar ulcers but usually result in major structural deformities of the feet. The primary risk factors for plantar ulceration are believed to be loss of protective sensation and the presence of high plantar pressures. Principal etiologic factors in the development of neuropathic fractures are hypothesized to be loss of protective sensation and bone demineralization. Major diabetic foot injuries are preventable by the use of comprehensive screening examinations and patient education. Patients at highest risk of injury should be seen more frequently and receive more extensive therapy. Successful management of plantar ulcerations is dependent on reduction of pressures under the foot and control of infection. Neuropathic fractures require long-term immobilization to promote healing followed by careful monitoring after removal of casts to prevent reinjury. Future research needs include prospective studies on risk factors and validation of treatment techniques.
最常报告的糖尿病足并发症是足底溃疡。神经性骨折的发生率低于足底溃疡，但通常会导致足部严重的结构畸形。足底溃疡的主要危险因素被认为是保护性感觉丧失和足底压力过高。神经性骨折发生的主要病因被推测为保护性感觉丧失和骨质脱矿。通过全面的筛查检查和患者教育，可预防主要的糖尿病足损伤。受伤风险最高的患者应更频繁就诊并接受更广泛的治疗。成功治疗足底溃疡取决于减轻足底压力和控制感染。神经性骨折需要长期固定以促进愈合，去除石膏后要仔细监测以防止再次受伤。未来的研究需求包括对危险因素的前瞻性研究和治疗技术的验证。
