小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 足溃疡
- 足痛
- 保护性感觉丧失
- 足部畸形
- 发热或寒战
其他诊断因素
- 不适感
- 厌食
- 足部红斑
- 足、踝关节或小腿水肿
- 足动脉搏动缺如
- 波动性
危险因素
- 足溃疡既往史
- 截肢既往史
- 感觉性神经病
- 外周动脉疾病
- 终末期肾病
- Charcot 中足畸形
- 结构性前足形变
- 踝关节活动受限（踝关节马蹄足）
- 视觉损害
- 血糖控制不佳
诊断性检查
首要检查
- 全血细胞计数 (FBC）
- 血糖水平
- 足部 x 线检查
需考虑的检查
- 微生物培养
- 红细胞沉降率
- C 反应蛋白
- 踝关节/足趾压力
- 肾功能
- 血管造影术
- MR 血管造影术
- CT 血管造影术
- 足部 MRI 检查
- 动脉双功超声
新兴检查
- 血清原降钙素
- 18 氟-脱氧葡萄糖 (FDG) PET/CT
治疗流程
首次就诊
初始确定性治疗后
撰稿人
作者
Frances L. Game, MBBCh, FRCP
Consultant Diabetologist and Clinical Director of R&D
Department of Diabetes and Endocrinology
University Hospitals of Derby and Burton NHS Foundation Trust
Derby
UK
利益声明
FLG is in receipt of research grants from the NIHR and MRC. She is National Clinical Lead for the National Diabetes Foot Audit of England and Wales, and is an NHS England regional Clinical Director. She is on the board of the International Working Group of the Diabetic Foot (IWGDF), and chaired both the Classification and Wound Healing Working Groups which produced the 2023 IWGDF guidelines. FLG is an author of a reference cited in the topic.
鸣谢
Dr Frances L. Game would like to gratefully acknowledge Dr Neal R. Barshes, Dr Joseph L. Mills, and Dr David G. Armstrong, previous contributors to this topic.
利益声明
NRB and DGA declare that they have no competing interests. JLM is a consultant for, and owns stocks in, Nangio TX; a member of the scientific advisory committees for Cesca, AnGes, and AstraZeneca; and the Co-National Principal Investigator for the Voyager trial of rivaroxaban in peripheral arterial disease patients undergoing intervention (funding for this institutional research grant goes directly to the Baylor College of Medicine).
同行评议者
Simon Ashwell, MBChB, MD, FRCP
Consultant Physician of Diabetes and Endocrinology
Diabetes Care Centre
The James Cook University Hospital
Middlesbrough
UK
利益声明
SA declares that he has no competing interests.
鉴别诊断
- 下肢静脉溃疡
- 痛风
- 急性 Charcot 关节病
更多 鉴别诊断指南
- 2023 年糖尿病诊疗标准
- 2023 年糖尿病诊疗标准
更多 指南
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