夏科脚

定义

夏科脚 is a condition that affects the bones, joints, and soft tissue in the feet and ankles. It can develop as a result of nerve damage in the feet due to diabetes or other nerve injuries.

选择的名字

Charcot joint; Neuropathic arthropathy; Charcot neuropathic osteoarthropathy; Charcot arthropathy; Charcot osteoarthropathy; Diabetic 夏科脚

原因

夏科足是一种罕见的致残疾病. 这是脚部神经损伤的结果. 一个常见的原因是 周围神经病变.

糖尿病 is the most common cause of this type of nerve damage. This damage is more common in people with type 1 diabetes. 当血糖水平长时间处于高水平时, both nerve and blood vessel damage occurs in the arms and legs.

Nerve damage makes it harder to notice the amount of pressure on the foot or if it is being stressed. The result is ongoing small injuries to the bones and ligaments that support the foot.

• You may develop bone stress fractures in your feet, yet never know it.
• Continuing to walk on the fractured bone often leads to further bone and joint damage.

导致足部损伤的其他因素包括:

• Blood vessel damage from diabetes can increase or change blood flow to the feet. 这会导致骨质流失. Weakened bones in the feet increase the risk of fracture.
• Injury to the foot signals the body to produce more inflammation-causing chemicals. 这会导致肿胀和骨质流失.

症状

早期足部症状可能包括:

• 轻微的疼痛和不适
• 发红
• 肿胀
• Warmth in the affected foot (noticeably warmer than the other foot)

在后期阶段, 脚上的骨头断裂，移动错位, 畸形的使脚或脚踝变形的.

• 夏可的一个经典标志是摇滚底脚. This occurs when the bones in middle of the foot collapse. This causes the arch of the foot to collapse and bow downward.
• 脚趾可能向下弯曲.

Bones that stick out at odd angles can lead to pressure sores and 足部溃疡.

• Because the feet are numb, these sores and ulcers may grow wider or deeper before they are noticed.
• High blood sugar also makes it hard for the body to fight infection. 因此，这些足部溃疡可能会感染.

考试和测试

早期诊断夏可足并不总是那么容易. It can be mistaken for sprains, bone infection, arthritis or joint swelling. Your health care provider will take your medical history and examine your foot and ankle.

Blood tests and other lab work may be done to help rule out other causes.

Your provider may check for nerve damage with these tests:

• 肌电描记术
• 神经传导速度测试
• 神经活检

The following tests may be done to check for bone and joint damage:

• 脚 x射线
• 核磁共振成像
• 骨扫描

脚 x射线 may look normal at early stages of the condition. Diagnosis often comes down to recognizing early symptoms of 夏科脚: swelling, 发红, 和受影响的脚的温暖.

治疗

治疗的目的是阻止骨质流失, 让骨头愈合, and prevent bones from moving out of place (deformity).

固定, 你的十大赌博平台排行榜会让你戴上全接触型石膏. 这将有助于限制你的脚和脚踝的活动. You will likely be asked to keep your weight off your foot entirely, 所以你需要使用拐杖, 一种膝关节行走装置, 或轮椅.

You will have new casts placed on your foot as the swelling comes down. 愈合可能需要几个月或更长时间.

防护鞋—— 一旦你的脚痊愈了, your provider may suggest footwear to help support your foot and prevent re-injury. 这些可能包括:

• 用夹板固定
• 牙套
• 矫正的鞋垫
• Charcot restraint orthotic walker, a special boot that provides even pressure to the whole foot

活动变化—— You will always be at risk for 夏科脚 coming back or developing in your other foot. 所以你的十大赌博平台排行榜可能会建议你改变活动, 比如限制你的站立或行走, 保护你的脚. You may need to use a wheelchair to limit activity on your feet.

手术, You may need surgery if you have 足部溃疡 that keep coming back or severe foot or ankle deformity. Surgery can help stabilize your foot and ankle joints and remove bony areas to prevent 足部溃疡.

持续监测—— You will need to see your provider for checkups and take steps 保护你的脚 for the rest of your life.

前景(预测)

The prognosis depends on the severity of foot deformity and how well you heal without infection. Many people do well with braces, activity changes, and ongoing monitoring.

可能出现的并发症

Severe deformity of the foot increases the risk of 足部溃疡. If ulcers or the underlying bone becomes infected and hard to treat, it may require 截肢.

何时联系医疗专业人员

Contact your provider if you have diabetes and your foot is warm, red, or swollen.

预防

Healthy habits can help prevent or delay 夏科脚:

• Keep good control of your blood glucose levels to help prevent or delay 夏科脚. But it can still occur, even in people with good diabetes control.
• 照顾好你的脚. 每天检查.
• 定期去看足部十大赌博平台排行榜.
• Check your feet regularly to look for cuts, 发红 and sores.
• 避免伤到脚.

参考文献

欧百喜，叶兰森，林A，穆尼奥斯，林S. Orthotic management of neuropathic and dysvascular feet. 见:韦伯斯特JB，墨菲DP，编. 矫形器和辅助器具图集. 5日艾德. Philadelphia, PA: Elsevier; 2019:chap 26.

刘建军，孙建军，刘建军，等. 糖尿病并发症. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. 威廉斯内分泌学教科书. 14日艾德. Philadelphia, PA: Elsevier; 2020:chap 37.

ElSayed NA, Aleppo G, Aroda VR, et al, on behalf of the American 糖尿病 Association. 12. Retinopathy, Neuropathy, and 脚 Care: Standards of Care in 糖尿病-2023. 糖尿病护理. 2023 1;46(增刊1):S203-S215. PMID: 36507636; PMCID: PMC9810462. pubmed.ncbi.nlm.国家卫生研究院.gov / 36507636 /.