Structural Changes in the Forefoot of Individuals with Diabetes and a Prior Plantar Ulcer

D. Robertson, Michael J. Mueller, Kirk E. Smith, P. Commean, T. Pilgram, J. Johnson
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引用次数: 101

Abstract

Background: Plantar ulcers produced by diabetic foot disease are devastating and costly. Better understanding of the ulcer-producing process is important to improve detection of feet that are at risk and to improve intervention. We identified and quantified soft-tissue and osseous structural changes in the forefoot of diabetic patients with a prior plantar ulcer.Methods: Thirty-two individuals with a mean age (and standard deviation) of 57 ± 11 years were studied; sixteen had diabetes (of a mean of 20 ± 11 years' duration), peripheral neuropathy, and a prior plantar ulcer, and sixteen were matched controls. Computed tomography was used to evaluate forefoot structure, including the plantar soft-tissue (muscle) density, soft-tissue thickness beneath the metatarsal heads, metatarsophalangeal joint angle, metatarsal bone density, and metatarsophalangeal joint arthropathy.Results: Plantar soft-tissue (muscle) density was lower in the individuals with diabetes (mean, 1 HU [Hounsfield unit]) than it was in the controls (mean, 18 HU). There was no difference in the soft-tissue thickness beneath the metatarsal heads (mean, 10 mm) between the individuals with diabetes and the controls, but the soft-tissue thickness decreased with age. The individuals with diabetes had greater extension deformity of the first, second, and third metatarsophalangeal joints and greater arthropathy of the second, third, and fourth metatarsophalangeal joints. There were no significant differences in metatarsal bone density between the groups.Conclusions: There were significant differences between the forefeet of individuals with diabetes and a previous plantar ulcer and those of controls: plantar muscle density was decreased, and metatarsophalangeal joint extension and arthropathy were increased. Interestingly, the soft-tissue thickness under the metatarsal heads in the controls was not greater than that in the diabetic patients.Clinical Relevance: This study demonstrated structural differences between the forefeet of patients with diabetes and a previous ulcer and those of normal age-matched controls. The information can serve to guide new interventions to prevent or treat foot ulcerations in this patient population.
糖尿病和足底溃疡患者的前足结构变化
背景:糖尿病足病引起的足底溃疡是毁灭性的,而且代价高昂。更好地了解溃疡的产生过程对于改善对有风险的足部的检测和改善干预措施是很重要的。我们确定并量化了患有足底溃疡的糖尿病患者的前足软组织和骨骼结构的变化。方法:选取平均年龄(及标准差)为57±11岁的32例个体进行研究;其中16人患有糖尿病(平均持续时间为20±11年)、周围神经病变和既往足底溃疡,16人作为匹配对照。使用计算机断层扫描评估前足结构,包括足底软组织(肌肉)密度、跖骨头下软组织厚度、跖趾关节角度、跖骨骨密度和跖趾关节病变。结果:糖尿病患者的足底软组织(肌肉)密度(平均1 HU [Hounsfield单位])低于对照组(平均18 HU)。糖尿病患者与对照组的跖骨头下软组织厚度(平均10毫米)无差异,但软组织厚度随年龄增长而下降。糖尿病患者的第一、第二和第三跖趾关节有较大的伸展畸形,第二、第三和第四跖趾关节有较大的关节病。两组间跖骨骨密度差异无统计学意义。结论:糖尿病患者和既往足底溃疡患者的前足与对照组存在显著差异:足底肌肉密度降低,跖趾关节伸展和关节病增加。有趣的是,对照组的跖骨头下的软组织厚度并不比糖尿病患者大。临床意义:本研究证明糖尿病患者和既往溃疡患者的前脚与正常年龄相匹配的对照组之间的结构差异。这些信息可以用于指导新的干预措施,以预防或治疗足部溃疡的患者群体。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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