Assessment and management of patients with diabeti
Abstract
Diabetic neuropathy is a common complication of diabetes. Patients need to be informed of the effects of poorly managed diabetes and appropriate care to prevent diabetic neuropathy. This article provides a brief overview of the main complications associated with diabetes and discusses the different types of diabetic neuropathy. Risk factors in the development of diabetic foot ulcers are identified and the importance of timely assessment is recognised. Treatment and management of diabetic foot ulcers is discussed in relation to blood glucose control, infection, wound care, sleep and pain.
摘要
糖尿病神經病變是糖尿病常見的併發症。患者需要被告知管理不善糖尿病之影響和適當的護理，以防止糖尿病神經病變。本文提供一個簡要概述的與糖尿病相關之主要併發症，及討論不同類型的糖尿病神經病變。糖尿病足潰瘍發展之危險因素，被識別與及時評估的重要性是公認的。治療及管理糖尿病足潰瘍討論與血糖控制、感染、傷口護理、睡眠和疼痛有關。
Aims and intended learning outcomes
This article aims to highlight and discuss neuropathy as a long-term complication of diabetes. It provides information about the different types of neuropathy and the risk factors involved in the development of a diabetic foot ulcer. After reading this article and completing the time out activities you should be able to:
Identify and define the different types of neuropathy that a person with diabetes may develop.
Recognise the risk factors for neuropathy and the development of a diabetic foot ulcer.
Consider the different elements and stages that should be included in a comprehensive foot examination of a person with diabetes.
Discuss the principles of diabetic foot ulcer management and treatment, drawing on knowledge that is relevant, up to date and evidence-based.
目標和預期的學習成果
本文主旨在強調和討論神經病變作為一個糖尿病長期的併發症。提供的資訊有關不同類型的神經病變和牽涉在糖尿病足部潰瘍發展的的危險因素。看完這篇文章並完成時間的活動後，你應該能夠：
識別和定義不同類型的神經病變、糖尿病患者可能發展。
認識神經病變的危險因素和糖尿病足潰瘍的發展。
考慮到糖尿病患者的不同的元素和階段，應包括在一個全面足部檢查。
討論糖尿病足潰瘍原則的管理和治療，對知識的基礎是相關的、最新的、有依據的。
Introduction
The prevalence of diabetes is increasing worldwide and is associated with high morbidity and mortality rates (Yokoyama et al 2007). At present, there are 2.9 million people in the UK diagnosed with diabetes and if trends continue, it is estimated that this figure will rise to 4.35 million in the next ten years (NHS Diabetes 2011). Approximately 15% of those with diabetes have type 1 diabetes and the remaining
85% have type 2 diabetes (Diabetes UK 2011).
Because of the autoimmune nature of type 1 diabetes, people who develop the condition can become acutely ill over a short period of time and are likely to require medical assistance. In contrast, type 2 diabetes is largely, but not exclusively, linked to obesity (Holt 2009). The development
of type 2 diabetes and its related signs and symptoms are often subtle and dismissed by the person experiencing them as being caused by other factors. These include feeling tired because the person is getting older or has a busy lifestyle, drinking more as the weather is warmer, and passing more urine because he or she is drinking more. As a result, a person can have type 2 diabetes for up to 12 years before he or she seeks medical help and a diagnosis is made. Consequently, 50% of people with type 2 diabetes may have already developed one or more complications of the condition at the time of diagnosis (Holt 2009).
Complications of diabetes, which are many and varied, affect the large blood vessels, resulting in cardiovascular disease, stroke and peripheral vascular disease. Diabetes also affects the microvascular systems of the body, causing retinopathy, nephropathy and neuropathy. Diabetic neuropathy is the most common long-term complication of type 2 diabetes (Boulton 1998). Peripheral neuropathy and vascular disease, the main contributors to foot disease, are found in more than 10% of people when they are diagnosed with diabetes (Boulton et al 2005a). In addition, the first year following diagnosis is a crucial period for the development of foot ulcers and amputations
(Boulton et al 2005a). People with diabetes have a 30-50% risk of developing chronic peripheral neuropathy, with 10-20% of those diagnosed with neuropathy going on to develop
severe neuropathic symptoms (Marshall and Flyvbjerg 2006).
介紹
糖尿病的發病率正在世界範圍內增加，並且與高發病率和死亡率有關。目前，有290萬人在英國診斷出患有糖尿病，如果趨勢持續下去，預計這數字在未來十年將上升到435萬。大約15％的糖尿病是第1型糖尿病，其餘85％是第2型糖尿病。由於第1型糖尿病患者的自體免疫體質，患者發展的條件可以在很短的時間週期成為重病，有可能需要醫療協助。相比之下，主要的第2型糖尿病，但不完全與肥胖有關。第2型糖尿病的發展及其相關的症狀和體徵往往是細微的，並駁回患者的經歷為其他因素造成的，這些包括感到疲倦，因為患者年老或有繁忙的生活方式、因天氣回暖喝更多，並通過多尿，因為他或她喝更多。其結果是，病人12歲之前患有第2型糖尿病，他或她尋求醫療幫助，並作出診斷。因此，50％患有第2型糖尿病患者在診斷時可能已經發展了一種或多種併發症。
糖尿病的併發症，這是多種多樣的，影響大血管，導致心血管疾病、中風和周圍血管疾病。糖尿病也影響身體的微血管系統，引起視網膜病，腎病和神經病。第2型糖尿病性神經病是最常見的長期併發症。周圍神經病變和血管疾病，主要出現於足部疾病，被發現超過10％當他們被診斷出患有糖尿病的人(有足部疾病)。此外，在第一年追蹤診斷為發展足潰瘍和截肢的關鍵時期。糖尿病病人有30-50％的風險發展為慢性周邊神經病變，有10-20％診斷為神經病變發展為嚴重的神經性症狀。
Complete time out activity(1)
Engage in discussion with people who have type 1 and type 2 diabetes, and with members of the multidisciplinary team, about the different types of diabetic neuropathy that they are aware of. Find out
if people have heard of the motor, sensory and autonomic nervous system. If so, are they able to discuss the differences and relate them to the care and management of diabetes?
完成超時活動(1)
(1): 有1型和2型糖尿病的人與學科小組的成員參與討論，他們都知道有關不同類型糖尿病性神經病。找出是否有人聽過的運動，感官和自主神經系統。如果是的話，他們是可以討論糖尿病的護理和管理的差異與關係？
Diabetic neuropathies
Neuropathy is defined as nerve damage and is a common and serious complication of diabetes
(Brem et al 2006). Damage to any nerve fibre is usually insidious and often goes unnoticed. If left untreated, damage to the nerve fibres will result in the development of an assortment of clinical signs and symptoms (Urbancic-Rovan 2005). Neuropathy is associated with cardiovascular disease and is therefore a marker of individuals who are at an increased risk of mortality (Bloomgarden 2007).
糖尿病神經病變
神經病被定義為神經損傷，並且是糖尿病常見而嚴重的併發症。損害任何神經纖維通常是隱伏的，往往被忽視。如果不進行治療，損傷的神經纖維，將導致
臨床症狀和表徵的各式各樣發展。神經病變是與心血管疾病相關的，因此，(心血管疾病)是個人增加死亡風險的標誌物。
Motor neuropathy
Mainly found in older people with type 2 diabetes, motor neuropathy occurs when there is damage to the nerves supplying the muscles of the body, resulting in muscle atrophy and weakness (Boulton et al 2005b). When the nerves supplying the muscles in the foot are damaged, these muscles are unable to
maintain the person’s healthy foot shape and the foot becomes deformed. This deformity leads to an alteration in the biomechanics of walking, and foot pressure points during standing and walking. Calluses form in abundance on the new, alien pressure points and sub-metatarsal head fat pads become thin. This increases the force of plantar pressure that ultimately results in the formation of a foot ulcer, which has a high risk of becoming infected (Urbancic-Rovan 2005).
運動型神經病變
主要見於有第2型糖尿病的老年人患者，發生運動型神經病變時，會損害神經供應身體的肌肉，導致肌肉萎縮及虛弱。當足部神經供應的肌肉損壞，這些肌肉不能夠維持人的健康腳形，及使腳變得畸形。這種畸形導致的改變，在生物力學的行走，以及站立和行走時足部的壓力點。癒傷組織紛紛形成新的，陌生的壓力點和次蹠骨頭脂的肪墊變細。這增加足底壓力的力量，最終導致足部潰瘍的形成，有被感染的高危險性。
Sensory neuropathy
The most common presentation of neuropathy in those with diabetes is sensory neuropathy, which affects up to 50% of patients (Boulton et al 2005b). It generally starts in the toes and over time may affect other areas such as the legs and hands (Bloomgarden 2007). It results when the sensory nerves become damaged and distorted messages are received by the brain relating to pain, pressure and temperature. This leads to decline of the normal sensations experienced by a person (Brem et al 2006). As the person is unable to feel the development of a lesion or an episode of trauma, he or she is unlikely to take the required evasive action and a foot ulcer may develop. The person may be unaware of this, especially if it is on the sole of the foot and cannot readily be seen (Figure 1). Because of the damaged nerve pathways, patients may complain of pain (Bloomgarden 2007) and a burning sensation in their lower limbs and feet, or they may feel like they are walking on hot coals or cotton wool. They can experience a deep aching pain in their legs, which is typically much worse at night. Other patients may be completely asymptomatic (Boulton et al 2005b).
感覺型神經病變
感覺型神經病變是糖尿病中最常見的表現，這影響多達50％的患者。它通常開始於腳趾和隨著時間的推移可能會影響到其他領域，例如腿和手。當感覺神經受損會導致，通過大腦的相關疼痛、壓力和溫度的接收消息能力失真。這導致患者所經歷的正常感覺減少。由於人是無法感受到病變的發展或創傷的發生，他或她是不太可能採取必要的迴避動作和足部潰瘍可能發展。患者可能不知道這一點，特別是如果它(傷口)是在腳底，並且不能容易地看出。由於受損的神經通路
，患者可能會抱怨疼痛，並在他們的下肢和腳有燒灼感，或者他們可能會覺得自己正走在熱炭或羊毛棉上。他們可以在自己的腿上體驗了深刻的筋骨疼痛，這通常是在夜間更糟糕。其他的患者可完全無症狀。
Autonomic neuropathy
A common condition in people with diabetes is autonomic neuropathy, which arises from damage to the sympathetic and parasympathetic nerves. It can affect several different systems in the body, resulting in high levels of morbidity and mortality. The clinical signs and symptoms of autonomic neuropathy can be diverse and varied, but tend to be linked mainly to disturbances of the cardiovascular system, digestive system and genitourinary system (Holt 2009).
自主神經病變
自主神經病變是在糖尿病患者中常見的情況，這起因於交感和副交感神經的損壞。它可以影響幾個在體內的不同系統，導致高度的發病率和死亡率的。自主神經病變的臨床症狀和體徵可多種多樣、五花八門的，但往往是主要與心血管系統、消化系統和生殖泌尿系統紊亂有關。
Charcot neuropathy
An uncommon condition, charcot neuropathy is an acute disease process that destroys the bones of the foot, leading to profound foot deformity (Figure 2). It is caused by increased blood flow to the feet, which ‘washes away’ the essential bone minerals leading to thinning of the foot bones. Charcot neuropathy is typically seen in patients with long-standing type 1 diabetes and is associated with poor diabetes control (Levy 2006). It can occur in those with type 2 diabetes, but this is less typical. Charcot neuropathy usually occurs as an acute phase following minor injury to the foot that may have gone unnoticed for some time, probably as a result of the additional presence of sensory neuropathy (Holt 2009).
Approximately 30% of patients complain of pain, but often X-rays of the foot at the time are surprisingly unremarkable and a bone scan would be required to determine the extent of any bone destruction (Holt 2009). If left untreated, the shape of the foot will begin to change irreversibly within just a few weeks and the person may begin to experience a ‘crunching’ sound when walking. The foot takes on a characteristic ‘rocker bottom’ appearance – where the natural arch of the
foot drops and the shape of the foot resembles the bottom of a rocking chair – which causes
pressure ulcers to develop on the plantar aspects. There will be evidence of new bone formation and partial or complete dislocation of the joints (Holt 2009).
夏科氏神經病變
一種罕見的情況下，夏科氏神經病變是一種急性疾病過程，破壞腳的骨骼，導致深遠足部畸形。它是造成足部血流增加，其“沖走”的基本骨骼的礦物質導致足部骨骼變薄。夏科氏神經病變常見於長期的第1型糖尿病患者與糖尿病控制不佳有關。它可以發生在第2型糖尿病患者，但這是不太典型。夏科氏神經病變通常發生於急性期伴有足部輕傷腳，可能已經被忽視了一段時間，可能由於感覺神經病的額外出現的結果。
大約30％的患者抱怨疼痛，但通常足部X光是出奇的平凡，以及需要一個骨掃描確定任何骨頭的破壞程度。如果不及時治療，腳的形狀將開始在幾個星期之內有不可逆的改變，患者可能開始行走時聽到‘嘎吱嘎吱'的聲音。腳下呈現一個特徵“搖擺底部'的出現 - 其中所述足部的自然拱形下垂和腳形類似於一個搖椅的底部 - 這會導致足底方面的壓瘡發展。將有新骨生成的證據和關節的部分或完全脫位。
Diabetic neuropathy is a common complication of diabetes. Patients need to be informed of the effects of poorly managed diabetes and appropriate care to prevent diabetic neuropathy. This article provides a brief overview of the main complications associated with diabetes and discusses the different types of diabetic neuropathy. Risk factors in the development of diabetic foot ulcers are identified and the importance of timely assessment is recognised. Treatment and management of diabetic foot ulcers is discussed in relation to blood glucose control, infection, wound care, sleep and pain.
摘要
糖尿病神經病變是糖尿病常見的併發症。患者需要被告知管理不善糖尿病之影響和適當的護理，以防止糖尿病神經病變。本文提供一個簡要概述的與糖尿病相關之主要併發症，及討論不同類型的糖尿病神經病變。糖尿病足潰瘍發展之危險因素，被識別與及時評估的重要性是公認的。治療及管理糖尿病足潰瘍討論與血糖控制、感染、傷口護理、睡眠和疼痛有關。
Aims and intended learning outcomes
This article aims to highlight and discuss neuropathy as a long-term complication of diabetes. It provides information about the different types of neuropathy and the risk factors involved in the development of a diabetic foot ulcer. After reading this article and completing the time out activities you should be able to:
Identify and define the different types of neuropathy that a person with diabetes may develop.
Recognise the risk factors for neuropathy and the development of a diabetic foot ulcer.
Consider the different elements and stages that should be included in a comprehensive foot examination of a person with diabetes.
Discuss the principles of diabetic foot ulcer management and treatment, drawing on knowledge that is relevant, up to date and evidence-based.
目標和預期的學習成果
本文主旨在強調和討論神經病變作為一個糖尿病長期的併發症。提供的資訊有關不同類型的神經病變和牽涉在糖尿病足部潰瘍發展的的危險因素。看完這篇文章並完成時間的活動後，你應該能夠：
識別和定義不同類型的神經病變、糖尿病患者可能發展。
認識神經病變的危險因素和糖尿病足潰瘍的發展。
考慮到糖尿病患者的不同的元素和階段，應包括在一個全面足部檢查。
討論糖尿病足潰瘍原則的管理和治療，對知識的基礎是相關的、最新的、有依據的。
Introduction
The prevalence of diabetes is increasing worldwide and is associated with high morbidity and mortality rates (Yokoyama et al 2007). At present, there are 2.9 million people in the UK diagnosed with diabetes and if trends continue, it is estimated that this figure will rise to 4.35 million in the next ten years (NHS Diabetes 2011). Approximately 15% of those with diabetes have type 1 diabetes and the remaining
85% have type 2 diabetes (Diabetes UK 2011).
Because of the autoimmune nature of type 1 diabetes, people who develop the condition can become acutely ill over a short period of time and are likely to require medical assistance. In contrast, type 2 diabetes is largely, but not exclusively, linked to obesity (Holt 2009). The development
of type 2 diabetes and its related signs and symptoms are often subtle and dismissed by the person experiencing them as being caused by other factors. These include feeling tired because the person is getting older or has a busy lifestyle, drinking more as the weather is warmer, and passing more urine because he or she is drinking more. As a result, a person can have type 2 diabetes for up to 12 years before he or she seeks medical help and a diagnosis is made. Consequently, 50% of people with type 2 diabetes may have already developed one or more complications of the condition at the time of diagnosis (Holt 2009).
Complications of diabetes, which are many and varied, affect the large blood vessels, resulting in cardiovascular disease, stroke and peripheral vascular disease. Diabetes also affects the microvascular systems of the body, causing retinopathy, nephropathy and neuropathy. Diabetic neuropathy is the most common long-term complication of type 2 diabetes (Boulton 1998). Peripheral neuropathy and vascular disease, the main contributors to foot disease, are found in more than 10% of people when they are diagnosed with diabetes (Boulton et al 2005a). In addition, the first year following diagnosis is a crucial period for the development of foot ulcers and amputations
(Boulton et al 2005a). People with diabetes have a 30-50% risk of developing chronic peripheral neuropathy, with 10-20% of those diagnosed with neuropathy going on to develop
severe neuropathic symptoms (Marshall and Flyvbjerg 2006).
介紹
糖尿病的發病率正在世界範圍內增加，並且與高發病率和死亡率有關。目前，有290萬人在英國診斷出患有糖尿病，如果趨勢持續下去，預計這數字在未來十年將上升到435萬。大約15％的糖尿病是第1型糖尿病，其餘85％是第2型糖尿病。由於第1型糖尿病患者的自體免疫體質，患者發展的條件可以在很短的時間週期成為重病，有可能需要醫療協助。相比之下，主要的第2型糖尿病，但不完全與肥胖有關。第2型糖尿病的發展及其相關的症狀和體徵往往是細微的，並駁回患者的經歷為其他因素造成的，這些包括感到疲倦，因為患者年老或有繁忙的生活方式、因天氣回暖喝更多，並通過多尿，因為他或她喝更多。其結果是，病人12歲之前患有第2型糖尿病，他或她尋求醫療幫助，並作出診斷。因此，50％患有第2型糖尿病患者在診斷時可能已經發展了一種或多種併發症。
糖尿病的併發症，這是多種多樣的，影響大血管，導致心血管疾病、中風和周圍血管疾病。糖尿病也影響身體的微血管系統，引起視網膜病，腎病和神經病。第2型糖尿病性神經病是最常見的長期併發症。周圍神經病變和血管疾病，主要出現於足部疾病，被發現超過10％當他們被診斷出患有糖尿病的人(有足部疾病)。此外，在第一年追蹤診斷為發展足潰瘍和截肢的關鍵時期。糖尿病病人有30-50％的風險發展為慢性周邊神經病變，有10-20％診斷為神經病變發展為嚴重的神經性症狀。
Complete time out activity(1)
Engage in discussion with people who have type 1 and type 2 diabetes, and with members of the multidisciplinary team, about the different types of diabetic neuropathy that they are aware of. Find out
if people have heard of the motor, sensory and autonomic nervous system. If so, are they able to discuss the differences and relate them to the care and management of diabetes?
完成超時活動(1)
(1): 有1型和2型糖尿病的人與學科小組的成員參與討論，他們都知道有關不同類型糖尿病性神經病。找出是否有人聽過的運動，感官和自主神經系統。如果是的話，他們是可以討論糖尿病的護理和管理的差異與關係？
Diabetic neuropathies
Neuropathy is defined as nerve damage and is a common and serious complication of diabetes
(Brem et al 2006). Damage to any nerve fibre is usually insidious and often goes unnoticed. If left untreated, damage to the nerve fibres will result in the development of an assortment of clinical signs and symptoms (Urbancic-Rovan 2005). Neuropathy is associated with cardiovascular disease and is therefore a marker of individuals who are at an increased risk of mortality (Bloomgarden 2007).
糖尿病神經病變
神經病被定義為神經損傷，並且是糖尿病常見而嚴重的併發症。損害任何神經纖維通常是隱伏的，往往被忽視。如果不進行治療，損傷的神經纖維，將導致
臨床症狀和表徵的各式各樣發展。神經病變是與心血管疾病相關的，因此，(心血管疾病)是個人增加死亡風險的標誌物。
Motor neuropathy
Mainly found in older people with type 2 diabetes, motor neuropathy occurs when there is damage to the nerves supplying the muscles of the body, resulting in muscle atrophy and weakness (Boulton et al 2005b). When the nerves supplying the muscles in the foot are damaged, these muscles are unable to
maintain the person’s healthy foot shape and the foot becomes deformed. This deformity leads to an alteration in the biomechanics of walking, and foot pressure points during standing and walking. Calluses form in abundance on the new, alien pressure points and sub-metatarsal head fat pads become thin. This increases the force of plantar pressure that ultimately results in the formation of a foot ulcer, which has a high risk of becoming infected (Urbancic-Rovan 2005).
運動型神經病變
主要見於有第2型糖尿病的老年人患者，發生運動型神經病變時，會損害神經供應身體的肌肉，導致肌肉萎縮及虛弱。當足部神經供應的肌肉損壞，這些肌肉不能夠維持人的健康腳形，及使腳變得畸形。這種畸形導致的改變，在生物力學的行走，以及站立和行走時足部的壓力點。癒傷組織紛紛形成新的，陌生的壓力點和次蹠骨頭脂的肪墊變細。這增加足底壓力的力量，最終導致足部潰瘍的形成，有被感染的高危險性。
Sensory neuropathy
The most common presentation of neuropathy in those with diabetes is sensory neuropathy, which affects up to 50% of patients (Boulton et al 2005b). It generally starts in the toes and over time may affect other areas such as the legs and hands (Bloomgarden 2007). It results when the sensory nerves become damaged and distorted messages are received by the brain relating to pain, pressure and temperature. This leads to decline of the normal sensations experienced by a person (Brem et al 2006). As the person is unable to feel the development of a lesion or an episode of trauma, he or she is unlikely to take the required evasive action and a foot ulcer may develop. The person may be unaware of this, especially if it is on the sole of the foot and cannot readily be seen (Figure 1). Because of the damaged nerve pathways, patients may complain of pain (Bloomgarden 2007) and a burning sensation in their lower limbs and feet, or they may feel like they are walking on hot coals or cotton wool. They can experience a deep aching pain in their legs, which is typically much worse at night. Other patients may be completely asymptomatic (Boulton et al 2005b).
感覺型神經病變
感覺型神經病變是糖尿病中最常見的表現，這影響多達50％的患者。它通常開始於腳趾和隨著時間的推移可能會影響到其他領域，例如腿和手。當感覺神經受損會導致，通過大腦的相關疼痛、壓力和溫度的接收消息能力失真。這導致患者所經歷的正常感覺減少。由於人是無法感受到病變的發展或創傷的發生，他或她是不太可能採取必要的迴避動作和足部潰瘍可能發展。患者可能不知道這一點，特別是如果它(傷口)是在腳底，並且不能容易地看出。由於受損的神經通路
，患者可能會抱怨疼痛，並在他們的下肢和腳有燒灼感，或者他們可能會覺得自己正走在熱炭或羊毛棉上。他們可以在自己的腿上體驗了深刻的筋骨疼痛，這通常是在夜間更糟糕。其他的患者可完全無症狀。
Autonomic neuropathy
A common condition in people with diabetes is autonomic neuropathy, which arises from damage to the sympathetic and parasympathetic nerves. It can affect several different systems in the body, resulting in high levels of morbidity and mortality. The clinical signs and symptoms of autonomic neuropathy can be diverse and varied, but tend to be linked mainly to disturbances of the cardiovascular system, digestive system and genitourinary system (Holt 2009).
自主神經病變
自主神經病變是在糖尿病患者中常見的情況，這起因於交感和副交感神經的損壞。它可以影響幾個在體內的不同系統，導致高度的發病率和死亡率的。自主神經病變的臨床症狀和體徵可多種多樣、五花八門的，但往往是主要與心血管系統、消化系統和生殖泌尿系統紊亂有關。
Charcot neuropathy
An uncommon condition, charcot neuropathy is an acute disease process that destroys the bones of the foot, leading to profound foot deformity (Figure 2). It is caused by increased blood flow to the feet, which ‘washes away’ the essential bone minerals leading to thinning of the foot bones. Charcot neuropathy is typically seen in patients with long-standing type 1 diabetes and is associated with poor diabetes control (Levy 2006). It can occur in those with type 2 diabetes, but this is less typical. Charcot neuropathy usually occurs as an acute phase following minor injury to the foot that may have gone unnoticed for some time, probably as a result of the additional presence of sensory neuropathy (Holt 2009).
Approximately 30% of patients complain of pain, but often X-rays of the foot at the time are surprisingly unremarkable and a bone scan would be required to determine the extent of any bone destruction (Holt 2009). If left untreated, the shape of the foot will begin to change irreversibly within just a few weeks and the person may begin to experience a ‘crunching’ sound when walking. The foot takes on a characteristic ‘rocker bottom’ appearance – where the natural arch of the
foot drops and the shape of the foot resembles the bottom of a rocking chair – which causes
pressure ulcers to develop on the plantar aspects. There will be evidence of new bone formation and partial or complete dislocation of the joints (Holt 2009).
夏科氏神經病變
一種罕見的情況下，夏科氏神經病變是一種急性疾病過程，破壞腳的骨骼，導致深遠足部畸形。它是造成足部血流增加，其“沖走”的基本骨骼的礦物質導致足部骨骼變薄。夏科氏神經病變常見於長期的第1型糖尿病患者與糖尿病控制不佳有關。它可以發生在第2型糖尿病患者，但這是不太典型。夏科氏神經病變通常發生於急性期伴有足部輕傷腳，可能已經被忽視了一段時間，可能由於感覺神經病的額外出現的結果。
大約30％的患者抱怨疼痛，但通常足部X光是出奇的平凡，以及需要一個骨掃描確定任何骨頭的破壞程度。如果不及時治療，腳的形狀將開始在幾個星期之內有不可逆的改變，患者可能開始行走時聽到‘嘎吱嘎吱'的聲音。腳下呈現一個特徵“搖擺底部'的出現 - 其中所述足部的自然拱形下垂和腳形類似於一個搖椅的底部 - 這會導致足底方面的壓瘡發展。將有新骨生成的證據和關節的部分或完全脫位。
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