Edmonds Michael, Manu Chris, Vas Prashanth
Diabetic Foot Clinic and Diabetic Department, King's College Hospital, London, SE5 9RS, UK.
Department of Diabetes, Faculty of Life Sciences and Medicine, King's College, Strand, London, WC2R 2LS, UK.
J Clin Orthop Trauma. 2021 Feb 8;17:88-93. doi: 10.1016/j.jcot.2021.01.017. eCollection 2021 Jun.
Neuropathy and ischaemia are two great pathologies of the diabetic foot which lead to the characteristic features of foot ulceration (neuropathic and ischaemic) and Charcot neuroarthropathy. These can be complicated by infection and eventually may result in amputation (minor or major) and increased mortality. All of these features contribute to considerable clinical and economic burden. Peripheral nerves in the lower limbs are susceptible to different types of damage in patients with diabetes leading to distinctive syndromes. These include symmetrical sensory neuropathy associated with autonomic neuropathy, which advances gradually, and acutely painful neuropathies and mononeuropathies which have a rather acute presentation but usually recover. Ischaemia in the form of peripheral arterial disease is an important contributor to the burden of the diabetic foot. The incidence of atherosclerotic disease is raised in patients with diabetes and its natural history is accelerated. Diabetes causes severe and diffuse disease below-the knee. The lifetime risk of developing a diabetic foot ulcer is between 19% and 34%. Recurrence is common after initial healing; approximately 40% of patients have a recurrence within 1 year after ulcer healing, almost 60% within 3 years, and 65% within 5 years. Charcot neuroarthropathy is characterised by bone and joint destruction on the background of a neuropathy. Its prevalence in diabetes varies from 0.1% to 8%. Infection develops in 50%-60% of ulcers and is the principal pathology that damages diabetic feet. Approximately 20% of moderate or severe diabetic foot infections result in lower extremity amputations. The incidence of osteomyelitis is about 20% of diabetic foot ulcers. Every 20 s a lower limb is amputated due to complications of diabetes. Of all the lower extremity amputations in persons with diabetes, 85% are preceded by a foot ulcer. The mortality at 5 years for an individual with a diabetic foot ulcer is 2.5 times as high as the risk for an individual with diabetes who does not have a foot ulcer. The economic burden exacted on health care systems is considerable and includes direct and indirect costs, with loss of personal earnings and burden to carers. The diabetic foot is a significant contributor to the global burden of disability and reduces the quality of life. It remains a considerable public health problem.
神经病变和缺血是糖尿病足的两大主要病理状况，可导致足部溃疡（神经病变性和缺血性）以及夏科氏神经关节病的特征性表现。这些情况可能会因感染而复杂化，最终可能导致截肢（小截肢或大截肢）并增加死亡率。所有这些特征都造成了相当大的临床和经济负担。糖尿病患者下肢的周围神经易受不同类型的损伤，从而导致不同的综合征。这些综合征包括与自主神经病变相关的对称性感觉神经病变，其呈渐进性发展；还有急性疼痛性神经病变和单神经病变，它们起病较为急性，但通常会恢复。外周动脉疾病形式的缺血是糖尿病足负担的一个重要因素。糖尿病患者动脉粥样硬化疾病的发病率升高，其自然病程也会加速。糖尿病会导致膝以下出现严重且弥漫性的疾病。发生糖尿病足溃疡的终生风险在19%至34%之间。初次愈合后复发很常见；约40%的患者在溃疡愈合后1年内复发，近60%在3年内复发，65%在5年内复发。夏科氏神经关节病的特征是在神经病变的背景下出现骨和关节破坏。其在糖尿病中的患病率从0.1%到8%不等。50% - 60%的溃疡会发生感染，感染是损害糖尿病足的主要病理状况。约20%的中度或重度糖尿病足感染会导致下肢截肢。骨髓炎的发病率约占糖尿病足溃疡的20%。每20秒就有一条下肢因糖尿病并发症而被截肢。在糖尿病患者的所有下肢截肢病例中，85%之前有足部溃疡。患有糖尿病足溃疡的个体5年死亡率是没有足部溃疡的糖尿病个体风险的2.5倍。对医疗保健系统造成的经济负担相当大，包括直接和间接成本，以及个人收入损失和护理人员的负担。糖尿病足是全球残疾负担的一个重要因素，会降低生活质量。它仍然是一个相当严重的公共卫生问题。
