Bernhard L M, Bakst M, Coleman W, Nickamin A
J Foot Surg. 1984 Jul-Aug;23(4):283-90.
Plantar space abscesses in the diabetic foot are relatively uncommon. These abscesses are an anatomic type of foot infection. Three plantar spaces have been identified: the medial, central, and lateral. The central plantar space is by far the most important. Within the central plantar space are tendons of the flexor digitorum longus, flexor digitorum brevis, quadratus plantae, lumbricales pedes, the medial and lateral plantar nerves, and the plantar arterial arch. Located within the lateral and medial spaces are the short flexor and abductor muscles to the first and fifth rays. Plantar space infections may arise from a variety of causes. Infections of the fibrofatty tissue of the toe pad or the long flexor tendon sheaths and lumbrical tendons secondary to web space infections, poor nail care, trauma, and mal perforans ulcers have been implicated. A medial incision is recommended for drainage of both the medial and central plantar spaces. This avoids a painful plantar scar and allows for extensive incision and drainage of these abscesses. The lateral plantar space is best drained by a lateral incision. Both incisions heal without a sensitive scar. Control of sepsis is of primary importance. If left uncontrolled, obliteration of the plantar arterial arch occurs. Necrosis of the distal foot and central three toes results, thereby preventing any effort to save the diabetic foot.
糖尿病足的足底间隙脓肿相对少见。这些脓肿是足部感染的一种解剖学类型。已确定有三个足底间隙：内侧、中央和外侧。其中，中央足底间隙最为重要。中央足底间隙内有趾长屈肌腱、趾短屈肌腱、跖方肌、蚓状肌、足底内侧神经和外侧神经以及足底动脉弓。位于外侧和内侧间隙的是第一和第五趾的短屈肌和外展肌。足底间隙感染可能由多种原因引起。趾垫纤维脂肪组织感染、蹼间隙感染继发的长屈肌腱鞘和蚓状肌腱感染、指甲护理不当、外伤以及穿通性溃疡都与之相关。对于内侧和中央足底间隙的引流，建议采用内侧切口。这样可避免形成疼痛的足底瘢痕，并能对这些脓肿进行充分的切开引流。外侧足底间隙最好通过外侧切口引流。两个切口愈合后都不会留下敏感的瘢痕。控制败血症至关重要。如果不加以控制，足底动脉弓会闭塞。继而导致足远端和中间三个脚趾坏死，从而使挽救糖尿病足的任何努力都付诸东流。
