Vas Prashanth, Chockalingam Nachiappan
Department of Diabetes and Diabetic Foot, King's College Hospital NHS Foundation Trust, London, UK.
Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK.
Clin Cosmet Investig Dermatol. 2023 Dec 12;16:3547-3560. doi: 10.2147/CCID.S333660. eCollection 2023.
Diabetic foot disease is a complex and challenging complication of diabetes mellitus, which imposes a significant burden of disease on patients, their carers, and the wider health systems. Recurrence rates are high, and current evidence indicates a high mortality associated with it. While management algorithms have primarily focused on the physical aspects of healing, there is increasing recognition of the critical role played by psychological and biomechanical factors in the development and resolution of diabetic foot disease. Therefore, in this paper, we aim to explore how diabetic foot outcomes can be improved by addressing not only the physical but also the psychological and biomechanical aspects that are integral to the development of this condition and its optimal resolution. We explore new technologies that allow for non-invasive objective assessment of the diabetic foot at risk, and we also explore the role of understanding biomechanics, which is essential to determining risk of foot disease, but also the potential for recurrence. In addition, we discuss the evidence linking depression and cognitive impairment to diabetic foot disease and offer our insight on the research direction required before implementing novel information into front-line clinics.
糖尿病足病是糖尿病一种复杂且具有挑战性的并发症，给患者、其护理人员以及更广泛的卫生系统带来了重大疾病负担。复发率很高，目前的证据表明与之相关的死亡率也很高。虽然管理算法主要侧重于愈合的身体方面，但人们越来越认识到心理和生物力学因素在糖尿病足病的发生和解决中所起的关键作用。因此，在本文中，我们旨在探讨如何通过不仅解决身体方面，还解决对这种疾病的发生及其最佳解决至关重要的心理和生物力学方面，来改善糖尿病足的治疗结果。我们探索能够对处于风险中的糖尿病足进行非侵入性客观评估的新技术，我们还探讨理解生物力学的作用，这对于确定足部疾病风险至关重要，同时也关乎复发的可能性。此外，我们讨论将抑郁症和认知障碍与糖尿病足病联系起来的证据，并就将新信息应用于一线临床之前所需的研究方向提供我们的见解。
