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The Foot in Diabetes - part 8

Mặc dù không phải tất cả các chân arthropathic thần kinh có thể được ngăn chặn, phá hủy sự tiến triển tiếp theo của bàn chân có thể được suy giảm thông qua việc phát hiện sớm và quản lý phù hợp. | 258 The Foot in Diabetes period7 8 15 34 35. Careful patient selection combined with expertise and close postoperative monitoring are essential for obtaining optimal surgical outcomes while minimizing complications. CONCLUSION Although not all neuro-arthropathic feet can be prevented the progression and subsequent destruction of the foot can be attenuated through early detection and appropriate management. This requires a thorough understanding of the underlying pathophysiology natural history and accepted standards of management. The ultimate goal of treatment is to maintain a useful extremity free from ulceration which will allow the patient to function as normally as possible throughout his her lifetime. While longitudinal studies have not been forthcoming regarding the survival of these patients they are certainly at risk for numerous other complications of diabetes. Prevention of ulceration and subsequent amputation is therefore a key objective in managing persons with this disorder. Constan t vigilanee on the part of both patient and health care providers is necessary to ensure that once healed the neuro-arthropathic foot is protected from further injury through appropriate footwear and careful attention to preventive foot care. REFERENCES 1. Charcot J-M. Sur quelques arthropathies qui paraissent dependre d une lesion du cerveau OU de la moelle epiniere. Arch Physiol Norm Pathol 1868 1 161-78. 2. Edelman SV Kosofsky EM Paul RA Kozak GP. Neuro-neuroarthropathy Charcot s joints in diabetes mellitus following revascularization surgery three case reports and a review of the literature. Arch Intern Med 1987 147 1504-8. 3. Frykberg RG Kozak GP. The diabetic Charcot foot. In Kozak GP Campbell DR Frykberg RG Habershaw GM eds Management of Diabetic Foot Problems 2nd edn. Philadelphia WB Saunders 1995 88-97. 4. Harris JR Brand PW. Patterns of disintegration of the tarsus in the anaesthetic foot. J Bone Joint Surg 1966 48B 4-16. 5. Newman JH. Spontaneous dislocation in