糖尿病性夏柯氏足：二例報告

Diabetic Charcot Foot: Report of Two Cases

糖尿病周邊神經病變是造成夏柯氏足(Charcot foot)的主要原因，其比率常被低估。本文提出夏柯氏足兩例供臨床醫師參考。病例1為75歲糖尿病周邊神經病變男性患者，足部變形，臨床診斷為夏柯氏足後轉介至復健科訂製治療鞋，但新鞋邊緣粗糙，加上赤腳穿鞋，導致破皮。因此，病人在家都光腳走路，結果引起右足蜂窩性組織炎，接受拇趾切除。病例2為68歲女性糖尿病患，在診斷出周邊神經病變半年後，左腳出現紅腫熱痛之發炎反應，理學檢查無發燒，實驗室檢查無白血球增多，細菌培養陰性，當時診斷為蜂窩性組織炎；兩年半後，病人因右大腿骨折住院，理學檢查發現足部變形，比較前後次住院期間之X光變化，都有楔狀骨骨折，跗骨關節破壞等現象，確診為夏柯氏足。因此，糖尿病周邊神經病變患者，若足部出現發炎反應，實驗室檢查無異常時，要懷疑是否為夏柯氏足，若足部變形，需訂做治療鞋時，要將粗糙的邊緣磨平，並穿著厚毛襪或棉襪以防止病足受傷。

The development of Charcot foot is highly associated with diabetic neuropathy, and its incidence may be underestimated. We describe two patients with diabetic Charcot foot. The first patient was a 75-year-old man with diabetic neuropathy about eight months. Deformity and bony destruction of the left foot was noted, and Charcot foot was diagnosed. Thereafter, he was referred to the Rehabilitation Department for protective shoes. Because of the rough surface in the margin of the shoes and the tendency of the patient not to wear socks, an abrasion wound in the left foot developed. He was reluctant to wear shoes and walked barefoot at home. The patient later developed cellulitis of the right foot and gangrene of the big toe, which eventually necessitated amputation of the big toe. The second patient was a 68-year-old woman with diabetic neuropathy about three years. She was admitted because of pain, swelling, erythema and heat in the left foot. There was neither leukocytosis nor bacterial growth from wound culture, and a diagnosis of cellulitis was made. Two-and-a-half years later, she was readmitted because of a fractured right femur. Radiological examination revealed deformities and bony destruction in both feet, which had also appeared in the X-ray films taken during the previous admission. Charcot foot was diagnosed. The cases should emphasize the need for the physicians to keep the possibility of acute Charcot process in mind when inflammatory changes and deformed foot are noted in patients with diabetic neuropathy. The margins of protective shoes should be smoothened, and patients should be reminded to wear socks for further protection.