Charcot foot

Definition

沙氏足是一种影响足部和脚踝骨骼、关节和软组织的疾病. 糖尿病或其他神经损伤可能导致足部神经损伤.

Alternative Names

Charcot joint; Neuropathic arthropathy; Charcot neuropathic osteoarthropathy; Charcot arthropathy; Charcot osteoarthropathy; Diabetic Charcot foot

Causes

Charcot foot is a rare and disabling disorder. It is a result of nerve damage to the feet. A common cause is peripheral neuropathy.

糖尿病是这种神经损伤最常见的原因. 这种损伤在1型糖尿病患者中更为常见. When blood sugar levels are high over a long time, 神经和血管损伤都发生在手臂和腿部.

神经损伤使人很难注意到足部所受的压力或足部是否受到压力. 其结果是支撑足部的骨骼和韧带受到持续的小损伤.

• 你可能会在你的脚上出现骨应力性骨折，但你却从不知道.
• 在骨折的骨头上继续行走往往会导致进一步的骨骼和关节损伤.

Other factors leading to foot damage include:

• 糖尿病造成的血管损伤会增加或改变足部的血流量. This can lead to bone loss. 脚部骨骼变弱会增加骨折的风险.
• 脚部受伤会向身体发出信号，使其产生更多引起炎症的化学物质. This contributes to swelling and bone loss.

Symptoms

Early foot symptoms may include:

• Mild pain and discomfort
• Redness
• Swelling
• 患病脚发热(明显比另一只脚发热)

At later stages, bones in the foot break and move out of place, causing the foot or ankle to become deformed.

• A classic sign of Charcot is rocker-bottom foot. 当脚中部的骨头塌陷时，就会发生这种情况. 这会导致足弓塌陷并向下弯曲.
• The toes may curl downward.

骨头以奇怪的角度伸出会导致压疮和 foot ulcers.

• 因为脚是麻木的，这些疮和溃疡可能在被发现之前变得更宽或更深.
• 高血糖也会使身体难以抵抗感染. As a result, these foot ulcers may become infected.

Exams and Tests

Charcot foot is not always easy to diagnose early on. 它可能被误认为是扭伤、骨感染、关节炎或关节肿胀. 你的医疗保健提供者会记录你的病史，并检查你的脚和脚踝.

血液检查和其他实验室检查可以帮助排除其他原因.

您的十大赌博平台排行榜可能会通过以下测试检查神经损伤:

• Electromyography
• Nerve conduction velocity tests
• Nerve biopsy

以下检查可以检查骨骼和关节损伤:

• Foot x-rays
• MRI
• Bone scan

脚部x光片在早期阶段可能看起来正常. 诊断通常归结为识别沙科足的早期症状:肿胀, redness, and warmth of the affected foot.

Treatment

The goal of treatment is to stop bone loss, allow bones to heal, 防止骨头移位(畸形).

Immobilization -- Your provider will have you wear a total contact cast. This will help limit movement of your foot and ankle. 你可能会被要求完全把你的重量从你的脚上拿开, so you will need to use crutches, a knee-walker device, or wheelchair.

脚肿消了以后，要给你打上新的石膏. Healing can take a couple of months or more.

Protective footwear -- Once your foot has healed, 你的十大赌博平台排行榜可能会建议你穿鞋来支撑你的脚，防止再次受伤. These may include:

• Splints
• Braces
• Orthotic insoles
• Charcot约束矫形助行器，一种特殊的靴子，为整个脚提供均匀的压力

Activity changes -- 你总是有沙可足复发的风险，或者在你的另一只脚上发展. So your provider may recommend activity changes, such as limiting your standing or walking, to protect your feet. 你可能需要使用轮椅来限制你的脚活动.

Surgery -- 如果你有不断复发的足部溃疡或严重的足部或踝关节畸形，你可能需要手术. 手术可以帮助稳定你的足部和踝关节，去除骨骼区域，防止足部溃疡.

Ongoing monitoring -- 你需要去看十大赌博平台排行榜做检查，并采取措施在余生中保护你的脚.

Outlook (Prognosis)

预后取决于足部畸形的严重程度以及在没有感染的情况下愈合的程度. 许多人在戴牙套、改变活动和持续监测的情况下都做得很好.

Possible Complications

严重的足部畸形会增加足部溃疡的风险. 如果溃疡或底层骨骼受到感染且难以治疗，可能需要 amputation.

When to Contact a Medical Professional

如果你有糖尿病，你的脚是温暖的，红肿的，联系你的十大赌博平台排行榜.

Prevention

健康的生活习惯有助于预防或延缓夏足病:

• 保持良好的血糖水平有助于预防或延缓夏可氏足. 但它仍然可能发生，即使是在糖尿病控制良好的人身上.
• Take care of your feet. Check them every day.
• See your foot doctor regularly.
• 定期检查你的脚，看看是否有割伤、红肿和溃疡.
• Avoid injuring your feet.

References

Baxi O, Yeranosian M, Lin A, Munoz M, Lin S. 神经性和血管障碍足的矫形治疗. In: Webster JB, Murphy DP, eds. Atlas of Orthoses and Assistive Devices. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 26.

Brownlee M, Aiello LP, Sun JK, et al. Complications of diabetes mellitus. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ编. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 37.

ElSayed NA, Aleppo G, Aroda VR等，代表美国糖尿病协会. 12. 视网膜病变，神经病变和足部护理:糖尿病护理标准-2023. Diabetes Care. 2023 1;46(Suppl 1):S203-S215. PMID: 36507636; PMCID: PMC9810462. pubmed.ncbi.nlm.nih.gov/36507636/.