Amsterdam UMC, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
Diabet Med. 2021 Apr;38(4):e14438. doi: 10.1111/dme.14438. Epub 2020 Nov 3.
To investigate people with Charcot midfoot deformity with regard to plantar pressure, footwear adherence and plantar foot ulcer recurrence.
Twenty people with diabetes, Charcot midfoot deformity, plantar foot ulcer history and custom-made footwear were assessed with regard to barefoot and in-shoe plantar pressures during walking, footwear adherence (% of daily steps over 7-day period) and plantar foot ulcer recurrence over 18 months. In a cohort design, they were compared to 118 people without Charcot foot (non-Charcot foot group) with custom-made footwear and similar ulcer risk factors.
Median (interquartile range) barefoot midfoot peak pressures were significantly higher in the Charcot foot group than in the non-Charcot foot group [756 (260-1267) vs 146 (100-208) kPa; P<0.001]. In-shoe midfoot peak pressures were not significantly higher in the Charcot foot group [median (interquartile range) 152 (104-201) vs 119 (94-160) kPa] and significantly lower for all other foot regions. Participants in the Charcot foot group were significantly more adherent, especially at home, than participants in the non-Charcot foot group [median (interquartile range) 94.4 (85.4-95.0)% vs. 64.3 (25.4-85.7)%; P=0.001]. Ulcers recurred in 40% of the Charcot foot group and in 47% of the non-Charcot foot group (P=0.63); midfoot ulcers recurred significantly more in the Charcot foot group (4/8) than in the non-Charcot foot group (1/55; P=0.001).
Effective offloading and very high footwear adherence were found in people with diabetes and Charcot midfoot deformity. While this may help protect against plantar foot ulcer recurrence, a large proportion of such people still experience ulcer recurrence. Further improvements in adherence and custom-made footwear design may be required to improve clinical outcome.
研究伴有夏科氏中足畸形的患者的足底压力、鞋类贴合度和足底溃疡复发情况。
20 名患有糖尿病、夏科氏中足畸形、足底溃疡病史和定制鞋具的患者在行走时接受了赤脚和穿鞋时的足底压力评估、鞋类贴合度（7 天内日常步数的百分比）以及 18 个月内的足底溃疡复发情况。采用队列设计，将他们与 118 名无夏科氏足（非夏科氏足组）和类似溃疡危险因素的患者进行比较，这些患者均使用定制鞋具。
夏科氏足组的中足峰值压力（中位数（四分位间距））明显高于非夏科氏足组[756（260-1267）比 146（100-208）kPa；P<0.001]。夏科氏足组的鞋内中足峰值压力无明显升高[中位数（四分位间距）152（104-201）比 119（94-160）kPa]，而所有其他足部区域的压力明显降低。夏科氏足组的患者明显比非夏科氏足组的患者更贴合鞋具，尤其是在家中[中位数（四分位间距）94.4（85.4-95.0）%比 64.3（25.4-85.7）%；P=0.001]。夏科氏足组的溃疡复发率为 40%，非夏科氏足组为 47%（P=0.63）；夏科氏足组的中足溃疡复发率明显高于非夏科氏足组（4/8 比 1/55；P=0.001）。
患有糖尿病和夏科氏中足畸形的患者中发现了有效的减压和极高的鞋类贴合度。虽然这可能有助于防止足底溃疡复发，但仍有很大一部分患者会出现溃疡复发。可能需要进一步提高贴合度和定制鞋具设计，以改善临床结果。
