Edmonds M E, Blundell M P, Morris M E, Thomas E M, Cotton L T, Watkins P J
Q J Med. 1986 Aug;60(232):763-71.
A specialized foot clinic for diabetic patients has made a detailed analysis of the presentation of diabetic foot ulcers and from this a new, organised approach to treatment has been derived. Over three years it has achieved a high rate of ulcer healing and reduced the number of major amputations. It has brought together the skills of chiropodist, shoe-fitter, nurse, physician and surgeon to manage the distinctive lesions of the neuropathic and ischaemic diabetic foot. The neuropathic ulcer was invariably associated with callus, whereas the ischaemic ulcer presented as areas of necrosis often from localised pressure of tight shoes. Essential aspects of management are specially constructed shoes, intensive chiropody and precise antibiotic treatment. Healing was achieved in 204 out of 238 (86 per cent) neuropathic ulcers and 107 out of 148 (72 per cent) ischaemic ulcers. Relapse rate in special shoes was 26 per cent compared with 83 per cent who preferred to wear their own shoes. In the two years before the establishment of the clinic, there were 11 and 12 major amputations yearly. This rate has now been reduced to seven, seven and five amputations yearly.
一家专门为糖尿病患者开设的足部诊所对糖尿病足溃疡的症状进行了详细分析，并据此得出了一种全新的、有组织的治疗方法。在三年多的时间里，该诊所实现了较高的溃疡愈合率，并减少了大截肢手术的数量。它整合了足病医生、鞋匠、护士、内科医生和外科医生的技能，以处理神经性和缺血性糖尿病足的独特损伤。神经性溃疡总是与胼胝有关，而缺血性溃疡则表现为坏死区域，通常是由紧鞋的局部压力所致。治疗的关键方面包括特制的鞋子、强化的足部护理和精确的抗生素治疗。238例神经性溃疡中有204例（86%）实现愈合，148例缺血性溃疡中有107例（72%）实现愈合。穿特制鞋的复发率为26%，而选择穿自己鞋子的复发率为83%。在诊所成立前的两年里，每年有11例和12例大截肢手术。现在这个比率已降至每年7例、7例和5例。
