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Atlas of the Diabetic Foot - part 3

Bệnh nhân phàn nàn của dysesthesias (cô ấy đã có một cảm giác lạnh hoặc ấm đôi chân của mình), và cô đã có tăng huyết áp mà cô đã được điều trị với enalapril kể từ khi 55 tuổi. Loét đã được nhận thấy 4 tuần trước đó và đã được gây ra bởi một chấn thương nhỏ bên ngoài. Kiểm tra, planus pes song phương với tăng sừng nhỏ | 42 Atlas of the Diabetic Foot Postoperative Hallux Valgus After Second Toe Removal First Ray Amputation Callus under Bone Prominence Callus over Prominent metatarsal Heads Hemorrhagic Callus Ulcer under a Callus Area Ulcer Under Hallux Heel Cracks Bilateral Chopart disarticulation Neuropathic Ulcer Ingrown Nails Onychocryptosis Anatomical Risk Factors for Diabetic Foot Ulceration 43 PES PLANUS FLAT FOOT A 73-year-old female patient with type 2 diabetes diagnosed at the age of 55 years and treated with insulin since the age of 65 years attended the diabetic foot clinic because of a small superficial painful ulcer over her medial malleolus. The patient complained of dysesthesias she had a cold or warm sensation in her feet and she had hypertension for which she had been treated with enalapril since the age of 55 years. The ulcer was noticed 4 weeks previously and had been caused by an external minor trauma. On examination bilateral pes planus with minor hyperkeratosis over the first metatarsal head was found Figure 3.1 . The ankle brachial index peripheral pulses vibration perception threshold and monofilament 5.07 sensation were all normal. The ulcer was debrided on a weekly basis and it healed in 4 weeks. Pes planus or flat foot is characterized by diminished longitudinal and transverse concavities of the foot. Diminished plantar transverse concavity is associated with an increase in frontal transverse convexity of the tarsometatarsal joint line Lis-franc joint line and divergence of the five metatarsal bones. The load transfer is displaced to the medial border of the midtarsal region. However there is evidence that flat feet protect against loading of the metatarsal heads although they are poor shock absorbers. Pes planus may cause bunionette formation and plantar heel spur pain but other foot problems are uncommon. Foot orthotics and arch supports do not alter the osseous relationships and are ineffective in many patients. Surgical treatment is rarely indicated .