Jarocki Christine, Schmidt Brian M, Holmes Crystal Murray
Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Hospital and Health System, Domino's Farms Lobby G, Suite 1500, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106 USA.
Clin Diabetes Endocrinol. 2019 Nov 7;5:14. doi: 10.1186/s40842-019-0089-4. eCollection 2019.
Diabetes mellitus continues to be a rising concern in the United States. It affects an estimated 9.4% of the population and approximately 1.5 million Americans are diagnosed annually. Approximately 85% of diabetic foot ulcers are associated with diabetic peripheral neuropathy and an infected diabetic foot ulcer is often the first sign of diabetes. There are countless studies within the literature that investigate how insensate feet and the manifestation of a foot ulcer further decrease quality of life and increase risk for mortality. Literature focuses on gait and kinematics that contribute to the formation of a diabetic foot ulcer. While pressure and shear forces are etiologic factors that may lead to the formation of diabetic foot ulcers, the position of the foot while driving an automobile has been ignored as a possible risk factor.
The clinical case will describe the events of healing a neuropathic diabetic foot ulcer beyond the standard of care treatment plan. It is one of the first case reports to describe vehicle ergonomics as an etiologic factor contributing to a diabetic foot ulcer. Once the patient becomes aware of the unnecessary source of pressure, education and care is provided to manage this likely source of daily pressure to the neuropathic foot.
The article emphasizes the importance of a complete assessment, including nontraditional factors, which may lead to diabetic complications.
糖尿病在美国仍然是一个日益受到关注的问题。据估计，它影响着9.4%的人口，每年约有150万美国人被诊断出患有糖尿病。大约85%的糖尿病足溃疡与糖尿病周围神经病变有关，而感染的糖尿病足溃疡往往是糖尿病的首个迹象。文献中有无数研究探讨了感觉迟钝的足部以及足部溃疡的表现如何进一步降低生活质量并增加死亡风险。文献关注的是导致糖尿病足溃疡形成的步态和运动学。虽然压力和剪切力是可能导致糖尿病足溃疡形成的病因，但驾车时足部的位置作为一个可能的风险因素却被忽视了。
该临床病例将描述在超出标准护理治疗方案的情况下治愈神经性糖尿病足溃疡的过程。这是首批将车辆人体工程学描述为导致糖尿病足溃疡的病因之一的病例报告。一旦患者意识到这种不必要的压力来源，就会提供教育和护理，以管理这种可能对神经性足部造成日常压力的来源。
本文强调了进行全面评估的重要性，包括可能导致糖尿病并发症的非传统因素。
