Nottingham University NHS Trust, Nottingham, U.K.
University Hospitals of Derby and Burton NHS Foundation Trust, Derby, U.K.
Diabetes Care. 2022 Jul 7;45(7):1691-1697. doi: 10.2337/dc21-2508.
It has been recognized since comprehensive descriptions by Jean-Martin Charcot in 1868 and 1883 that development of what is usually known as neuropathic osteoarthropathy (or the Charcot foot) requires the coincidence of neuropathy and inflammation. Despite this, detailed understanding of the causes has remained remarkably limited in the succeeding century and a half. The aim of this descriptive account is to draw particular attention to the processes involved in both the onset and resolution of the inflammation that is an essential component of active disease. The principal observation is that while neuropathy is common in people with diabetes, the inflammation and secondary skeletal damage that characterize neuropathic osteoarthropathy are observed in only a small minority of people with diabetes and with neuropathy. We therefore argue that the key to understanding the causes of the Charcot foot is to focus equally on those who have active disease as well as those who do not. Although neuropathy is essential for development of the disorder, neuropathy also has an adverse impact on the mechanisms involved in the onset of inflammation, and these may be critically affected in the majority of those who are susceptible. The Charcot foot is uncommon in people with diabetes (or any other cause of neuropathy) because the large majority of those with neuropathy may have also lost the capacity to mount the specific inflammatory reaction that is essential for its development.
自 1868 年和 1883 年让-马丁·夏科（Jean-Martin Charcot）全面描述以来，人们已经认识到，通常被称为神经病变性骨关节炎（或夏科足）的发展需要神经病和炎症同时发生。尽管如此，在接下来的一个半世纪里，对其病因的详细了解仍然非常有限。本描述性叙述的目的是特别关注炎症发生和消退过程，炎症是活动性疾病的一个重要组成部分。主要观察结果是，虽然糖尿病患者中常见神经病，但只有一小部分糖尿病合并神经病患者会出现特征性的神经病变性骨关节炎的炎症和继发性骨骼损伤。因此，我们认为，了解夏科足病因的关键是同样关注那些患有活动性疾病的患者以及那些没有患病的患者。尽管神经病是该病发展的必要条件，但神经病也会对炎症发生所涉及的机制产生不利影响，而这些机制在大多数易感患者中可能受到严重影响。糖尿病患者（或任何其他神经病原因）中夏科足并不常见，因为大多数神经病患者可能已经丧失了引发其发展所必需的特定炎症反应的能力。
