Pathomechanics of diabetic foot ulcers: challenging the status quo

摘要 在美国，每年大约有13万例与足部溃疡相关的截肢手术， 每年约1000亿美元，对糖尿病患者的生活质量有很大影响。 旨在预防溃疡的减压鞋是主要的预防措施，但它已经 已经被证明只有微不足道的效果。非常需要更有效的预防措施 鞋类，只有通过更好地了解溃疡才能发展 病理力学。这项纵向研究将在一组糖尿病患者身上进行。 神经病和既往溃疡病史估计平均超过12个月。使用最先进的 设备，两个主要的溃疡引起因素将在每月的随访中被量化 期间；足底剪切力和温度，以及压力和体力活动。目的 本研究旨在寻找更准确的足部溃疡标记物和/或标记物组合。 调查人员还将分析这四个因素的时间轨迹，以确定潜在的趋势 走向溃烂。这项研究的独特性是因为使用了一种新的设备， 随着时间的推移，通过多次测量来测量3D足部应力及其纵向设计。 最近的研究表明，足底剪应力在溃烂中的重要性。这项研究将 探讨切应力位置与口腔溃疡的纵向关系 第一次。足部温度的变化和与溃疡的潜在相关性将被揭示。 识别和了解可靠的溃疡标记物可能会带来革命性的 预防措施，包括开发鞋类，以监测和尽量减少 溃疡风险。

ABSTRACT Approximately 130,000 foot ulcer related amputations are performed each year in the US, costing about 100 billion dollars annually and at great impact to the quality of life of diabetic patients. Pressure-reducing footwear aimed at preventing ulcers is the main preventive measure, but it has been shown to be only meagerly effective. There exists a great need for more effective preventive footwear, which can only be developed through a better understanding of ulceration pathomechanics. This longitudinal study will be conducted on a cohort of patients with diabetic neuropathy and a prior ulcer history over an estimated mean of 12 months. Using state-of-the-art equipment, two primary ulcer-causing factors will be quantified every month over the follow-up period; plantar shear and temperature, along with pressure and physical activity. The purpose of this study is to identify more accurate markers and/or marker combinations for foot ulceration. Investigators will also analyze time trajectories of the four factors to identify potential trends towards ulceration. The uniqueness of the study is due to employment of a novel device capable of measuring 3D foot stresses and its longitudinal design with multiple measurements over time. Recent studies have shown the significance of plantar shear stresses in ulceration. This study will explore a longitudinal association between the locations of shear stresses and ulceration for the first time. Variations in foot temperature and potential relevance to ulceration will be revealed. Identifying and understanding reliable ulceration markers could lead to revolutionary preventative measures including development of footwear that monitors and minimizes ulceration risks.