Pathomechanics of diabetic foot ulcers: challenging the status quo

摘要 在美国，每年约有130，000例足部溃疡相关截肢手术， 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 被证明只有微弱的效果。非常需要更有效的预防措施 鞋类，这只能通过更好地了解溃疡的发展 病理力学这项纵向研究将在糖尿病患者队列中进行， 神经病变和既往溃疡病史，估计平均12个月。使用最先进的 设备，两个主要的溃疡引起的因素将量化每个月的后续行动 期间;足底剪切和温度，沿着的压力和体力活动。的目的 本研究是为了鉴定用于足部溃疡的更准确的标记物和/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 走向溃疡。这项研究的独特性是由于采用了一种新的设备， 测量3D足部应力及其纵向设计，随时间进行多次测量。 最近的研究表明足底剪切应力在溃疡形成中的重要性。本研究将 探讨纵向之间的联系的剪切应力和溃疡的位置， 首次将揭示足部温度的变化和与溃疡形成的潜在相关性。 识别和理解可靠的溃疡标记物可能会导致革命性的 预防措施，包括开发鞋类， 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.