Makhalidwe a nsapato zamatumbo a anthu odwala matenda ashuga

Kupanga malingaliro

kwa odwala matenda ashuga

O.V. Udovichenko1, V.B. Bregovsky6, G.Yu. Volkova5, G.R. Galstyan1, S.V. Gorokhov1, I.V. Gurieva2, E.Yu. Komelyagina3, S.Yu. Korablin2, O.A. Levina2, T.V. Gusov4, B.G. Spivak2

Endocrinology Research Center RAMS, 2 Federal Bureau of Medical and Social Expertise of the Ministry of Health and Social Development, 3 Endocrinology Dispensary of the Department of Health of Moscow, 4 Moscow Medical Academy a pambuyo I.M. Sechenova, Center ya 5 yopanga nsapato zapadera "Ortomoda", Moscow,

6 Malo Omwe Akulumikizana ndi Matenda a Zomera, St.

Gawo 1. Zofunikira zonse za nsapato

Mitundu ya zilonda zam'munsi zam'magazi a shuga mellitus (DM) ndizosiyanasiyana. Kupanda kuganizira za mawonekedwe a wodwala wina kumabweretsa kuti nsapato zopangidwa ndi mafupa nthawi zambiri sizikhutiritsa odwala kapena madokotala. Zovala zamtundu uliwonse, kuphatikiza mafupa, zimatha kupangidwa molakwika ngati zingapangitse phazi la wodwala matenda ashuga. Chifukwa chake, kuwongolera kokhazikika kwa nsapato zopangidwa ndikutsatira kwawo zovuta za wodwalayi ndikofunikira kwambiri. Motere, oimira mabungwe osiyanasiyana a endocrinological ndi orthopedic mbiri adapanga upangiri wolumikizana popanga nsapato zamatumbo, poganizira zovuta zingapo zamatenda omwe ali ndi odwala matenda ashuga.

Pakadali pano, nsapato zapadera za odwala matenda ashuga zimawerengedwa ngati othandizira (ofanana ndi mankhwala), komwe ndikofunikira kuyika zofunikira zomwezo pakuwunika mtundu ndi ntchito bwino muzolemba zotsimikizira, kuphatikiza mayesero olamulidwa mosasamala. K. Wfc ^ E. Cb1e1ai akuwonetsa kuti mtundu uliwonse wa nsapato zapadera za "matenda ashuga" amafunika mayeso osankhidwa mwapadera kuti atsimikizire kuchepetsedwa kwa zilonda zam'mimba. Chiwerengero chambiri cha kafukufuku wam'nyumba komanso chakunja pa nsapato zamatenda a shuga zalembedwa, ndipo ntchito izi zimapanganso maziko a malingaliro awa.

Zojambula zam'madera akumunsi

odwala matenda ashuga

5-10% ya odwala onse omwe ali ndi matenda ashuga amakhala ndi matenda a shuga (SDS), mawonekedwe akulu omwe ndi mabala osachiritsa (zilonda zam'mimba), gangrene, kudulidwa. Tanthauzo la VTS tsopano

"Kulowerera, zilonda ndi / kapena kuwonongeka kwa minofu yakuya yokhudzana ndi kusokonezeka kwa mitsempha komanso kuchepa kwa magazi m'mitsempha yam'munsi yamitunda yosiyanasiyana" Odwala omwe ali ndi zotupa zam'munsi kwambiri chifukwa cha matenda ashuga, omwe sangakwaniritse tanthauzo ili, atha kupezeka ndi matenda omwe ali ndi chiwopsezo cha matenda ashuga kapena matenda ashuga a m'mitsempha kapena angiopathy am'munsi.

Neuropathy, angiopathy ndi kupunduka kwamapazi (omalizirawa sikuti nthawi zonse amayamba chifukwa cha matenda ashuga) ndizinthu zazikulu zomwe zimatsogolera ku SDS. Matenda a diabetes a neuropathy amapezeka mu 30-60% ya odwala, amaphwanya kumva kwamiyendo ndikupanga zotupa za pakhungu popanda kupweteka komanso osadziwika, ndipo kupsinjika kwa phazi mu nsapato ndizosavomerezeka. Angiopathy imachitika mu 10-20% ya odwala, koma imasokoneza kwambiri machiritso a zilonda zapakhungu pang'ono, ndikuthandizira pakusintha kwawo kukhala minofu necrosis. Kusintha (Hallux valgus, kuwonjezeka kwa mitu ya mafupa achitsulo, chikhodzodzo ndi chala, komanso zotulukapo za kupindika mkati mwa phazi ndi kufooka kwa mafupa chifukwa cha matenda ashuga) kumabweretsa kugawidwanso kwakukulu kwa katundu kumapazi, kuwoneka kwa zigawo za nsapato zazitali, kuponderezedwa kwa phazi mu nsapato, zomwe zimabweretsa kuwonongeka ndi necrosis ya zimakhala zofewa za phazi.

Zimatsimikiziridwa kuti nsapato zapamwamba kwambiri za orthopedic kwambiri (nthawi 2-3) zimachepetsa chiwopsezo cha VDS 9.18-i.e. ili ndi njira yothandiza kwambiri yopewera kuposa mankhwala ambiri omwe adapangidwira chifukwa chaichi. Koma popanga nsapato, munthu ayenera kukumbukira kuwopsa kwa khungu la mapazi ndi matenda ashuga komanso kusamva bwino, ndichifukwa chake wodwalayo samamva kusasangalala, ngakhale nsapatoyo itakhala yopanikizika kapena kuvulaza phazi. Nsapato za Odwala

Ma comrade omwe ali ndi matenda ashuga ndiosiyana kwambiri ndi nsapato zamatumbo zomwe zimagwiritsidwa ntchito matenda ena.

Mitundu ya nsapato zamatumbo kwa odwala matenda ashuga

Nsapato zamadzimadzi zimatchedwa nsapato, kapangidwe kake kamene kamapangidwa poganizira kusintha kwa pathological mu matenda ena. Ngakhale nsapato zonse za odwala omwe ali ndi matenda ashuga ndizovuta kwambiri, ndizofunikira kuchokera pamawonekedwe azachipatala kuti azitha kusiyanitsa: a) nsapato zamadzimadzi zopangidwa molingana ndi gawo lomalizidwa, ndi b) nsapato zopangidwa molingana ndi chipika chimodzi (chipinda chomalizidwa kusinthidwa kwa wodwala wopatsidwa kapena pulasitala zoponya / zofanana nawo). Popeza palibe mawu okhazikitsidwa a nsapato zamtunduwu (mawu oti "zovuta" ndi "osavuta" ali ndi tanthauzo laukadaulo), ndikofunika kugwiritsa ntchito mawu oti "nsapato pabuloli lomalizidwa" ("nsapato zomalizidwa") ndi "nsapato pagawo lina", zomwe zikufanana ndi mawu akunja " nsapato-za-zigamba (zokutidwa-kale) ndi "nsapato zopangidwa". Akatswiri angapo amati kuyitanitsa nsapato pamalo osamalitsa "kupewa" (makamaka, kukonza malingaliro a odwala), koma malingaliro awa samavomerezedwa.

Popeza nsapato zamatumbo ndi insoles ndizolumikizana mosiyanasiyana, ziyenera kulingaliridwa palimodzi, zomwe zimawonekeranso ndikupanga izi.

Zizindikiro zamtundu wa nsapato zapamwambazi

Kuvala "nsapato pamalowo": phazi lopanda zovuta + kukula kwake lomwe limakwanira m'mabowo omwe alipo (poganizira kukula kwawo ndi kukwanira kwawo).

Kwa "munthu payekha": kulemera kwakukulu + kukula sikakukwana maphara wamba. Monga zitsanzo, zotchulidwa

mawonekedwe (Hallux valgus III - IV zaka mazana ena ndi ena), kuchepa mphamvu chifukwa cha matenda ashuga a m'magazi ("kugwedeza phazi" ndi zina), kudula chala cha I kapena V, kuduladula zala zingapo (ngakhale akatswiri ena amakhulupirira kuti pakalibe zovuta zina, " nsapato pazomalizira "ndi insole inayake yopanga).

Kutengera mkhalidwe wam'mphepete mwam'munsi (kupezeka kwa zopunduka, ischemia, neuropathy, zilonda ndi zotupa mu anamnesis), magulu osiyanasiyana a odwala omwe ali ndi zosowa zosiyanasiyana zamankhwala am'magazi 1,2,6,7,14 amadziwika. Mtundu wa nsapato zamatumbo ndi zamkati zimasankhidwa kutengera mtundu womwe wodwalayo ali. Popeza kuperewera kwakanthawi kovuta kwa matenda a diabetesic neuropathy ndi angiopathy m'misonkhano yambiri yamankhwala, kufotokoza kwa magulu awa m'malingaliro awa kumawonetsedwa mu mawonekedwe osavuta komanso makamaka kutengera kupsinjika kwa miyendo (posowa deta pa neuropathy / angiopathy, wodwalayo ayenera kuganiziridwa kuti atha kukhala ndi zovuta izi).

Gulu 1 (chiopsezo chochepa cha VDS - 50-60% ya odwala onse): mapazi opanda zopunduka. 1a - ndi mphamvu yachibadwa, 16 - ndi kusokonekera kwamphamvu. Atha (1a) kugula nsapato zopangidwa kale m'sitolo wamba, koma malinga ndi malamulo ena osankha nsapato kapena (16) amafunika "nsapato zomalizidwa" zokhala ndi insole yofatsa.

Gawo lachiwiri (chiwopsezo cholimba cha SDS - 15-20% ya odwala onse): zoperewera zolondola (digiri ya Hallux valgus I-II, zolankhula zotsekemera za coracoid ndi nyundo, flatfoot, kufalikira kofatsa kwa mitu ya mafupa achitsulo, etc.) 1. Amasowa "nsapato pamalunda omalizidwa" (nthawi zambiri owonjezera) okhala ndi bulasi yopanga payokha.

Gawo lachitatu (chiwopsezo chachikulu cha SDS - 10-15% ya odwala): zofooka kwambiri, kusintha kwa khungu koyamba, zilonda zam'mimba (zokhudzana ndi kuchuluka kwambiri pamiyendo mukamayenda) m'mbuyomu, kudula kwamkati mkati mwa phazi. Afunika "nsapato" payokha ndi ma insoles opangidwa pawokha.

Gulu 4 (5-7% ya odwala): zilonda zam'mimba ndi mabala panthawi yoyesedwa. Nsapato za Orthopedic ndizopanda ntchito, zotumiza zinthu ("theka nsapato", Total Contact Cast (TCC)) zimafunikira pamaso pochiritsa mabala, mtsogolomo - nsapato za orthopedic zamagulu 2 kapena 3.

1 Choyimira "kusinthitsa" kwa kusinthika apa ndikulingana kwa kukula konse kwa miyendo kumapazi omwe alipo.

Zowonongeka zazitali komanso kuthamanga kwa magalimoto (komanso zizindikiro za kusakwanira kwa nsapato zopangidwa) nthawi zambiri zimafuna kuti wodwalayo apatsidwe gawo lapamwamba.

Njira zakuchitikira nsapato zamatumbo / ma insoles

Ntchito za nsapato zamatumbo mwa odwala matenda ashuga

• Ntchito yayikulu: kuchepetsa kukakamiza kwa magawo a malo oyambitsidwa (omwe angakhalepo kale kusintha kwa zilonda). Ndi chifukwa cha ntchitoyi kuti kupangidwe kwapadera kwa nsapato zamatumbo ndi insoles ndikofunikira. Ntchito zotsalira zimatha kuthetsedwa ndi nsapato zapamwamba zopanda mafupa.

• Pewani kuzungulira kwamiyendo (mphamvu za ubweya), musataye khungu la kumapazi. Mu shuga, chidwi chambiri chimalephera, khungu limakhala losatetezeka. Chifukwa chake, kusinthasintha kwamatumbo poyenda nthawi zambiri kumayambitsa kukula kwa chilonda cha matenda ashuga.

• Musataye phazi, ngakhale ndi zopunduka (nthawi zambiri ndi hallux valgus), osavulala ndi nsonga yolimba

Tetezani phazi kutsogolo ndi mikwingwirima ina (ngakhale muzochita za tsiku ndi tsiku kumenyedwa kotere kumabweretsa chitukuko cha VTS kawirikawiri).

• Kuphatikiza pazakapangidwe kamakina - kupereka mpweya wabwino wokwanira, kutonthoza, kupepuka mukavala ndikuchotsa, kuthekera kosintha voliyumu masana.

Zotsatira zake, cholinga chachikulu cha nsapato zamatumbo ndiziteteza phazi kuti lisapangidwe zilonda zam'mimba. Tiyeneranso kugogomezera kuti si nsapato zamathambo (zomwe sizothandiza pamenepa) zimagwiritsidwa ntchito pochiza zilonda zam'mimba, koma zida zotsitsira kwakanthawi.

Kodi nsapato zimathetsa bwanji vuto lalikulu - zimachepetsa kuchuluka kwa magawo akomweko? Zinthu zotsatirazi zikufotokozedwa kuti zikwaniritsa izi.

1. Wokhazikika wokhazikika (wokhazikika wokha) wokhala ndi mpukutu. Kuchepetsa katundu poyenda pamphumi, kumawonjezeka - pakati ndi kumbuyo.

Mkuyu. 2. Nsapato zokhala ndi ma rigid okhazikika ndi yokulungira.

Mkuyu. 3. Metatarsal pilo (MP mwachisawawa).

Madontho amawonetsa mitu ya mafupa achitsulo, katundu amene amachepetsa pansi pa pilo la metatarsal.

Mkuyu. 4. Metatarsal roller (mwachisawawa).

Madontho amawonetsa mitu ya mafupa achitsulo.

Mkuyu. 5. Ikani mawonekedwe a zinthu zofewa mu makulidwe a insole (1) komanso mkati mwa nsapato (2).

2. Metatarsal pad (metarsal pad) "amadzutsa" mafupa achitsulo, akumachepetsa katunduyo pamutu pawo.

3. Chingwe cha metatarsal bar (metatarsal bar) chimachitanso chimodzimodzi, koma chili ndi mulifupi wokulirapo - kuchokera m'mphepete mwamkati mwa insole mpaka kunja

4. Insole, kubwereza mawonekedwe a phazi ndikupanga zinthu zopatsa mphamvu (mawonekedwe owumbika). Kuchepetsa kupsinjika pamagawo omwe ali ndi zovuta, kuyika pazinthu zofewa m'malo awa (ma insole plugs) thandizo.

5. Pansi pa malo olemedwa kwambiri, tchuthi chokha chokha chimatha kupangidwa, chodzazidwanso ndi zofewa (zolumikizira midsole) (onani mkuyu. 5).

Tiyenera kudziwa kuti njira zingapo (mwachitsanzo, mapilo a metatarsal) sizingagwiritsidwe ntchito mwa wodwala aliyense, zisonyezo ndi zotsutsana nawo zimakambidwa pansipa).

Zofunikira pakatikati pa nsapato zamatumbo

kwa odwala matenda ashuga

Izi zofunikira zidapangidwira kumbuyo kwa ntchito ya F. Tovey pamaziko a chidziwitso cha mphamvu, zidatsimikiziridwa pambuyo pake pamayesero azachipatala a nsapato zapadera ndipo masiku ano ambiri amavomerezedwa2.

• Osachepera chiwerengero cha seams ("kusoka").

• Kutalika kwa nsapato sikotsika kuposa kupingasa kwamiyendo (makamaka pama metatarsophalangeal joints).

• voliyumu yowonjezerapo mu nsapato (zophatikizira ma insoles a orthopedic).

• Kuperewera kwa chala cap3: zinthu zotanuka (zotambasulidwa) zapamwamba komanso zingwe.

• Kutalika kwam'mbuyo, kufikira pamitu ya mafupa achitsulo (kumalipirira kutaya mphamvu ndi kusasunthika komwe kumayenderana ndi kusowa kwa kapu yayitali).

• Voliyumu yosunthika (yokhala ndi ma lows kapena ma Velcro fasteners ngati zotupa ziwonjezeka madzulo).

Zojambula zowonjezera zimapangidwanso kuti ndizovomerezeka kwa mitundu yonse ya nsapato za matenda ashuga:

• Osasunthika (okhazikika) okha ndi cholembera (rocker kapena roller - onani pansipa). M'mitundu ingapo yotsogola yomwe imatsogolera matenda ashuga (Lucro), kachidindo kakang'ono ka 4 kali pamitundu yonse ya matenda ashuga, ngakhale, mwachiwonekere, sikofunikira kwa odwala onse.

• chidendene chakumaso chakumaso (cholumikizira mbali pakati pa chidendene cha kutsogolo ndi cholowera chachikulu chimachepetsa chiopsezo cha kugwa).

Zofunikira za insoles za matenda ashuga

• Kupanga zinthu zopatsa mphamvu (pulasitiki, chithovu cha polyurethane) yokhala ndi zotanuka mu gawo lakunja la gombe la 20 ° (pafupifupi wofanana ndi kutanuka kwa tinthu tating'onoting'ono ta adipose), kumbuyo - pafupifupi 40 °. Cork ndi pulasitiki sizinthu zofowoketsa kwambiri komanso zolimba kwambiri ndipo siziyenera kugwiritsidwa ntchito kuchirikiza mbali yayitali ya phazi komanso ngati maziko (otsika pansi) kumbuyo kwa bulalo. Pachifukwa ichi, zida zotanuka (mphira, thovu, evaplast, ndi zina) zimagwiritsidwa ntchito.

• Makulidwe a insole a magulu a odwala 2 ndi 3 - osachepera 1 cm, ngakhale gawo la anterior5.

• Kukwanira bwino kwa zinthuzo.

• Bokosi lolimba lokwanira limatha kuchepetsa kukakamizidwa kwa odwala omwe ali pachiwopsezo chambiri (ndipo insole iyi imagwiritsidwa ntchito mu nsapato zakunja zamitundu yotsogola). Komabe, ndi mkulu chomera

- chojambulidwa mwachikuda. b - mawonekedwe osiyanitsa ndi nsapato opanda chala chakumaso (top top).

kupanikizika kwa insole, komwe kumayendetsa mawonekedwe a phazi ndikuchirikiza miyendo yake, kumachotsa zochulukirapo molingana ndi zojambula pafupi ndi 4.7.

• Akatswiri akunja R. Zick, P. Cavanagh 6.7 amalingalira njira yomwe amavomerezera yogwiritsa ntchito zinthu zofewa pamakulidwe a insole pamiyala yodzaza ndi phazi (mapulagi a insole). Kuyika kumeneku kumatha kuzama mu kukula kwa nsapato yokha (midsole plug), komabe, kafukufuku wazachipatala pankhaniyi ndiwosowa kwambiri.

• Moyo wawutali kwambiri wa insoles wogwira ntchito ndi miyezi 6-12. Wodwalayo ayenera kuchenjezedwa za kufunika kopanga insoles zatsopano (kapena m'malo mwa zida za insole) osachepera 1 pachaka.

Malinga ndi kuyezetsa kwakanthawi kachipatala, kwa chaka 1 chogwiritsa ntchito "nsapato yomalizidwa" (Lucro), chiwopsezo cha kubwereza m'matumbo chinachepa ndi 45%, NNT (kuchuluka kwa odwala omwe amafunikira kupatsidwa chithandizo chotere kuti apewe vuto limodzi la zilonda) anali 2.2 wodwala pachaka. Zina zapadera za mtundu wa nsapatozi zinali: a) cholimba chokhazikika ndi mpukutu, b) chapamwamba chofewa chopanda chala chakumaso, c) chingwe chofewa chododometsa (chopangidwa popanda munthu) chokhala ndi makulidwe 9 mm m'magawo onse phazi.

2 Izi ndizofunikira pakapangidwe ka nsapato zam'magazi zamagulu kalikonse kwa odwala matenda ashuga, koma kukhazikitsa kwawo pakokha sikupangitsa nsapato kukhala zothandiza popewa zilonda zam'mimba. Kuti muthane ndi vutoli, nsapato ziyenera kupangidwa poganizira zovuta zenizeni za wodwala, monga tafotokozera pansipa.

3 Toe cap - gawo lolimba la gawo lapakatikati la nsapato, lomwe lili m'chigawo chala chakumanzere kwake ndikuthandizira kuteteza zala kuchokera kuzokopa zakunja ndikukhalanso mawonekedwe a nsapato. Pakafukufuku (Presch, 1999), kukhalapo kwa kapu yayala kuphazi chinali chimodzi mwazifukwa zazikulu zitatu zomwe zimapangitsa kuti pakhale vuto la zilonda zam'mimba mutavala nsapato zamadzimadzi (kuphatikizapo kuvala nsapato wamba komanso kulakwitsa kolakwika kwa nsapato ndi mawonekedwe a phazi lomwe lili ndi mawonekedwe osalala)

4 Mu nsapato za Lucro, roller imasunthidwa pang'ono kunja ("pre-beam roll"), mtunda wa "malo ogawanikana" kuchokera chidendene ndi 65-70% wa kutalika kokhako, kutalika kokweza kuli pafupifupi masentimita 1-2. (Mitundu ndi mawonekedwe ofunikira a mpukutuwo afotokozedwa bwino zofotokozedwa mu gawo lachiwiri la nkhaniyi.

Zovala zotere nthawi zambiri zimafunikira nsapato zakuthambo zowonjezera - izi ndizopangira nsapato zopangidwa ndi orthopedic.

Kupanga kwa mafupa

nsapato zopangidwa ndi zinthu zachilengedwe zokha?

Pachikhalidwe chathu ndimakhulupirira kuti zinthu zachilengedwe zokha ndizomwe zimayenera kugwiritsidwa ntchito chifukwa cha ukhondo wabwino kwambiri (hygroscopicity, air permeability, etc.). Komabe, atawonekera kupanga zinthu zopangidwa mwapamwamba kwambiri kuposa zachilengedwe pakukula (foam fox) kapena kuthekera kwa cushioning (plastazot, siloprene popanga ma insoles), kuyika kukana kupanga zinthu mokomera zachilengedwe kulibe chifukwa chokwanira.

Orsoopedic insoles ndilovomerezeka

opanda nsapato zapadera?

Popeza kuti makulidwe ochepera a orthopedic insole kuti atsimikizire kutulutsa kwa 1 cm mu gawo lakunja, kuyikika payokha zopangidwa mu nsapato zopanda orthopedic zomwe amavala wodwala ndizosavomerezeka, chifukwa nthawi zambiri zimayambitsa kupezeka kwa zilonda zam'mimba. Kupanga ma insoles kotheka kumatha pokhapokha ngati wodwala ali ndi nsapato zakuzama kwambiri (zopangidwa molingana ndi gawo lomalizidwa kapena la block), lolingana ndi izi.

Mu gawo lalikulu la odwala (makamaka okalamba), masitepe ambiri patsiku amatengedwa kunyumba, osati pamsewu, kotero kuti pachiwopsezo chachikulu cha zilonda zam'mimba, kumatula "magawo owopsa" kumapazi kuyenera kuchitikira kunyumba. Nthawi yomweyo, kusintha ma insoles a ma orthopedic nawonso sikothandiza. Kunyumba, ndikofunikira kuvala nsapato zotseguka theka (zotsekera), momwe ma insoles amadzimadzi amayikika ndikukhazikika. Koma ziyenera kukumbukiridwa kuti nthawi yozizira, mapazi a wodwala sayenera kuti atenthe. Nsapato zotere zimatha kukhala ndi okhazikika pokhapokha. Ndikothekanso kuvala nsapato za orthopedic yachilimwe kunyumba.

Kuunika Kwabwino ndi Kugwira Mtima

Ndizosatheka kukhazikitsa nsapato zodzaza ndi mafupa popanda kukhala mkati nthawi zonse (ndi msonkhano womwewo) komanso kunja (kuchokera kumbali ya asing'anga, poganizira malingaliro a odwala) kuwongolera nsapato zopangidwa bwino.

Ndi mtundu wa bwino kumatanthauza kufanana kwa nsapato kumalingaliro (malingaliro) poganizira zovuta zamankhwala za wodwala.

Kuchita nsapato ndikuthekera kwake poletsa kukula kwa zilonda zam'mimba zomwe zimagwirizanitsidwa ndi kuvulala kwa phazi

poyenda. Kuchita bwino kwa nsapato kungayerekezeredwe ndi njira zotsatirazi:

1) Kugwiritsa ntchito malo okhala m'mphepete mwa nsapato (muyeso wa nsapato),

2) kuchepetsa kusintha kwa zilonda zam'mbuyo mu "malo owopsa",

3) Kuchepetsa pafupipafupi zilonda zatsopano (kupatula zomwe sizikugwirizana ndi nsapato) bola atavalidwa pafupipafupi.

Njira No. 2 ndiyothandiza kwambiri pakuwunika zotsatira za kuvala nsapato m'dwala linalake, njira No. 3 - mayesero olamulidwa mwachisawawa. Tiyeneranso kukumbukiranso kuti momwe zotsatira za mayesero azachipatala zimatengera chiwopsezo cha matenda am'mbuyomu odwala omwe amaphatikizidwa ndi phunziroli. Chifukwa chake, prophylactic zotsatira za nsapato zamatumbo zimatsimikiziridwa mu ntchito zomwe zimakhudza odwala ochokera ku gulu lowopsa kwambiri (zilonda zam'matumbo) 3,5,12,13,15, koma sizinatsimikizidwe m'magulu ochepera 12,17,19. Ndikofunikira kuti maphunzirowa aziganizira osati kuchuluka kwathunthu kwa zilonda zatsopano, komanso kuchuluka kwa zilonda zomwe zimayambitsidwa ndi nsapato zosakwanira (zilonda zokhudzana ndi nsapato).

Muzovuta, nsapato sizingatheke, ngakhale zitapangidwa "bwino." Wodwala amatha kuvala nsapato zapamwamba komanso zamtengo wapatali, zomwe zimangokhala zopanda pake pamenepa. Pankhaniyi, ndikofunikira kukonza nsapato zopangidwa kuti zitheke pazotsatira zomwe mukufuna (kuchotsedwa kwa malo ochulukirapo panthawi yazosamba + kusakhalapo kwa zilonda zatsopano). Wodwala wokhala ndi chiwopsezo chosazolowereka (kutembenuka kwamphamvu kwa phazi kunjaku), chilonda chimabwereranso m'chigawo cha mutu wa fupa loyambirira la metatarsal, ngakhale nsapato zili ndi okhazikika pokhapokha komanso yokulungira. Zojambulajambula zawonetsa kuti pakuyenda pali "kugudubuza katundu" kudera la zilonda. Kupanga nsapato zokhala ndi axis ya rollar roll pamakona mpaka kutsinde la nsapato (perpendicular to the axis of kuyenda kwa phazi nthawi yamkokomo) kumalepheretsa kubweretsanso chilonda.

Kuphunzitsa wodwala kuvala koyenera

Ichi ndi chimodzi mwazomwe zimagwiritsidwa ntchito mosalekeza (kutsatira kwa odwala). Mukamapereka nsapato zamatumbo, ndikofunikira kukumbukira kuti:

- zimangopindulitsa ndikovala pafupipafupi (> 60-80% ya nthawi yonse yoyenda) Chantelau, 1994, Striesow, 1998,

- nsapato ndi insole - gawo limodzi: simungathe kusinthitsa insoles zamankhwala ku nsapato zina,

- ndikofunikira kuyitanitsa ma insoles osachepera kamodzi pachaka (ndi kupanikizidwa kwambiri kwamitchi - nthawi zambiri),

- Kuvala nsapato zamatumbo ndizofunikira kunyumba. Izi ndizowona makamaka kwa odwala omwe ali ndi kuthamanga kwamitengo yambiri komanso iwo omwe ali ndi gawo pang'ono loyenda kunja kwa nyumba (anthu okalamba ambiri).

Kukhalapo kwa nsapato zamatumbo sizimapatsa mwayi wodwala pakufunika kutsatira "Malamulo Oletsa Kupewa Matenda A Diabetes", makamaka, pokhudzana ndi cheke cha nsapato tsiku ndi tsiku kuti mudziwe zinthu zakunja zomwe zalowa mmalo mwake, zingwe zopindika, ma insoles, etc.

Kuyesedwa pafupipafupi muofesi ya Diabetesic Foot ndikofunikira, makamaka, kuchotsa panthawi yake ma hyperkeratoses omwe amatha kupanga ngakhale mutavala nsapato zapamwamba kwambiri (chifukwa nthawi zina ndi nsapato za orthopedic / insoles ndizotheka kuchepetsa, koma osathetsa, chiwopsezo chofalikira pamtunda wa chomera. nkhope ya phazi).

Kugwiritsa ntchito chokhazikika pokhapokha ndi mpukutu kumafuna maphunziro owonjezera kwa wodwalayo. Ndikofunika kuchenjeza pasadakhale kuti njira yodziwika bwino yowongolera bwino mukamagula nsapato monga momwe kugwirira ntchito ndi manja anu sikugwira ntchito pano. Kuyenda mu nsapato zotere kumafunikira njira yosiyanako pang'ono (gawo lowumiriza limachepetsedwa) ndipo kutalika kwa sitepe kumachepetsedwa.

Zowoneka bwino za nsapato za orthopedic

Nkhani izi ziyenera kukumbukiridwa nthawi zonse. Kusakhutira kwa wodwalayo (wodwalayo) maonekedwe a nsapato akuipiraipira kwambiri -

Kutsatira mogwirizana ndi kugwiritsidwa ntchito kwake. Njira zingapo zakhala zikufunsidwa kuti zipititse patsogolo malingaliro a nsapato ndi odwala (ndipo, koposa zonse, ndi odwala) 7.11. Chilolezo cha wodwalayo kuvala nsapato za orthopedic chitha kuchitika ndi zinthu zokongoletsa (nsapato zowoneka bwino), mawonekedwe amtundu wa wodwalayo, kutenga nawo mbali pakapangidwe ka nsapato, etc. Ngati muyenera kuvala nsapato zapamwamba, ngakhale nyengo yotentha, gwiritsani ntchito njira yotalikirana monga yayikulu (1.5-2 masentimita) mabowo kumtunda kwake. Popanda kusokoneza phazi lakukhazikika, amapanga nsapato kukhala "chilimwe", komanso amalimbikitsidwa akamavala. Popanga nsapato zokhala ndikutulutsa zomwe zimafunikira kuti zichepetse kutalika kwa chidendene chake kuti muchepetse kukula kwake konse. Kudzaza chala cha nsapato mukadula mbali yakumapeto kwa phazi, pakati pazinthu zina, kumathetsanso vuto lakukonzanso zokongoletsa.

Kutsatira malamulo apamwambawa ndizofunikira popanga nsapato kwa odwala matenda ashuga. Koma ngakhale nsapato yotchedwa orthopedic (ndipo mwanjira yake ili), sizitanthauza kuti adapangidwa moyenera kuti athane ndi mavuto a wodwala wina. Kuti muthane ndi mavutowa, ndikofunikira kumvetsetsa malamulo a biomechanical malinga ndi zotsatira za kafukufukuyu, zomwe tidzakambirana m'gawo lachiwiri la nkhaniyi.

1. Spivak B.G., Guryeva I.V. Mawonetsedwe azachipatala a kusintha kwa ma pathological kumapazi a odwala omwe ali ndi matenda ashuga komanso mfundo za kuthandizira kwa mafupa / Prosthetics ndi ma prosthetics (Wolemba ntchito TsNI-IPP), 2000, ayi. 96, p. 42-48

2. FGU Glavortpomosch wa Unduna wa Zantchito ku Russian Federation. Malangizo Nambala 12 / 5-325-12 "Pozindikira, kunena za mabizinesi amtundu wa mafupa ndi ma orthopedic (malo ochitira misonkhano) ndikupereka nsapato zamatumbo kwa odwala omwe ali ndi matenda ashuga othamanga". Moscow, Seputembara 10, 1999

3. Baumann R. Industriell gefertigte Spezialschuhe fur den diisischen Fuss./ Diab.Stoffw, 1996, v.5, p. 107-112

4. Basi SA, Ulbrecht JS, Cavanagh PR. Kupsinjika kwapanikizika ndikugawidwanso kwamphamvu ndi insoles zopangidwa mwa odwala matenda ashuga omwe ali ndi neuropathy ndi kupunduka kwamapazi./ Clin Biomech. 2004 Jul, 19 (6): 629-38.

5. Busch K, Chantelau E. Kugwira ntchito kwatsopano kwa nsapato za 'matenda ashuga' kuti muteteze ku matenda obwera chifukwa cha matenda ashuga. Kafukufuku woyembekezera. / Mankhwala A shuga, 2003, v.20, p.665-669

6. Cavanagh P., / nsapato kapena anthu odwala matenda ashuga (zokambirana). International Symposium "Diabetesic Phazi". Moscow, Juni 1-2, 2005

7. Cavanagh P., Ulbrecht J., Caputo G. The biomechanics of the foot inabetes mellitus / Mu: The Diabetesic Foot, 6th edition. Mosby, 2001., p. 125-196

8. Chantelau E, Haage P. / Kuyendera kwamiyendo yodwala matenda ashuga: kuyenderana ndi kutsatira kwa wodwala./ Diabetes Med, 1994, v. 11, p. 114-116

9. Edmonds M, Blundell M, Morris M. et al. / Kupititsa patsogolo kupulumuka kwa phazi la odwala matenda ashuga, gawo lachipatala chapadera. / Quart. J. Med, 1986,

v. 60, No232, p. 763-771.

10. Gulu Logwira Ntchito Padziko Lonse Lapansi pa odwala matenda ashuga. Consensus yapadziko lonse pa phazi la odwala matenda ashuga. Amsterdam, 1999.

11. Kuzindikira matenda a Morbach S. Hartmann Medical Edition, 2004.

12. Reiber G, Smith D, Wallace C, et al. / Zotsatira zakuchira kwa nsapato pakuthamanga miyendo kwa odwala matenda ashuga. Yesero lolamulidwa mwachisawawa./ JAMA, 2002, v.287, p.2552-2558.

13. Samanta A, Burden A, Sharma A, Jones G. kuyerekezera pakati pa nsapato za "LSB" ndi nsapato za "space" mu zilonda zam'mimba za shuga ./ Diabetes.Intern, 1989, v. 6, p. 26

14. Schroeer O. Zolemba za nsapato zamatumbo a shuga (maphunziro). Nsapato zamatumbo kwa odwala matenda a shuga mellitus (Sayansi ndi semina yothandiza). ESC RAMS, M., Marichi 30, 2005

15. Striesow F. Konfektionierte Specialschuhe zur Ulkusrezidivprophylaxe beim diabetesischen Fusssyndrom. / Med. Klin. 1998, vol. 93, p. 695-700.

16. Tovey F. Kupanga nsapato za matenda ashuga. / Mankhwala A shuga, 1984, vol. 1, p. 69-71.

17. Tyrrell W, Phillips C, Mtengo P, et al. Ntchito ya orthotic mankhwala pochepetsa chiopsezo cha ulceration mu phazi la matenda ashuga. (Abstract) / Diabetesologia, 1999, v. 42, Suppl. 1, A308.

18. Uccioli L., Faglia E, Monticone G. et al. / Nsapato zopangidwa pofuna kupewa zilonda zam'mimba za matenda ashuga. / Chisamaliro cha shuga, 1995, v. 18, No10, p. 1376-1378.

19. Veitenhansl M, Hierl F, Landgraf R. / Ulkus- und Rezidivprophylaxe durch vorkonfektionierte Schuhe bei Diabetesikem mit diabetesisches Fusssyndrom: eine prespektive randomisierte Studie. (Abstract) ./ Diabetes & Stoffwechsel, 2002, v. 11, Suppl. 1, p. 106-68

20. Zick R., Brockhaus K. Matenda a shuga: Fußfibel. Leitfaden fur Hausa'rzte. - Mainz, Kirchheim, 1999

Gawo 2. Kusiyanitsa kosiyanasiyana kwa magulu osiyanasiyana a odwala

Nsapato zamatumbo kwa odwala matenda ashuga nthawi zonse ayenera kukwaniritsa zofunikira zomwe zaperekedwa gawo loyambirira la nkhaniyi. Komabe, mavuto a malekezero am'munsi mu shuga ndi osiyanasiyana, ndipo magulu osiyanasiyana a odwala amafunikira nsapato zovuta komanso mapangidwe osiyanasiyana. Mukamasanthula mapazi a wodwalayo musanapange nsapato (makamaka ndikutenga nawo gawo la orthopedist), ndikofunikira kumvetsetsa chifukwa chake wodwalayo cholinga chake ndikupanga nsapato. Kusokonekera kosiyanasiyana kumatsogolera pakuchulukitsa magawo osiyanasiyana phazi. Chifukwa chake, mayankho olimbikitsa pakupanga nsapato sangakhale ofanana kwa odwala onse. Makamaka yogwira ntchito iyenera kukhala kutsitsa madera omwe khungu limasinthasintha ulcerative (ma hyperkeratoses omwe ali ndi zotupa, ma hyperkeratoses opweteka kumtunda kwa plantar, cyanosis ndi khungu la khungu kumbuyo). Nazi njira zotetezera "zigawo za chiopsezo" kuti zisalembe kwambiri komanso kupanga zilonda zam'mimba zosiyanasiyana.

1. Transverse flatfoot (kufalikira kwa mitu ya mafupa achitsulo), kusintha kwa ulcerative m'malo a mitu ya II, III, IV metatarsal bones.

Kuchulukitsa kwa dothi lam'maso pamphumi ndi mapazi osalala kumakulirakulira chifukwa cha kusokoneza kwina kwa matendawa - kuchepetsa kuchepa kwa mafupa a tarsus ndi chidendene, ukulu wa cholumikizira chamchiberekero (chifukwa cha kufupika kwa minofu ya ng'ombe). Ntchito ya nsapato ndikugawa katundu, kuchepetsa kuthamanga m'malo opanikizika.

Njira zoperekera katundu

Osakhazikika ndi mpukutu. Mpukutu weniweni wotsegula wamtambo ndi wosiyana kwambiri ndi kutukuka kwa gawo la chala cholumikizidwa mu nsapato (yomwe nthawi zambiri imakhala mpaka 1.5 cm kwa nsapato zazitali. Kusiyanako kukugona pakusintha kwa kokhako kutsogolo komanso kutalika kwa chala (2.25-3.75 cm). Malangizo pakugwiritsa ntchito njirayi malinga ndi maphunziro ambiri 9,17,25 akufotokozedwa mwatsatanetsatane ndi P. Cavanagh et al .:

• Sankhani Rocker sole (mbali yakumapeto ya mzere wosweka) ndi Roller yekha (mbali yakumapeto ngati mawonekedwe ofotanirana). Njira yoyamba ndiyothandiza (kuwonjezeranso kuchepetsa9-9%, malinga ndi kutsika mkati mwa nsapato).

Mkuyu. 7. Mitundu ya rollar roll.

b - Rocker (malongosoledwe mu lembalo).

Muvi umawonetsa komwe “malo opatula”.

• Malinga ndi kafukufuku, kutalika kwenikweni kwa "malo opatulira" kuchokera chidendene ndi 55-65% kutalika kokhako (pafupi ndi 55 ngati mukufuna kumasula mitu ya mafupa achitsulo, pafupi ndi 65 kuti mumasule zala zawo).

• Kugawika kwamphamvu kwa katundu kumatsimikizika ndi kutalika kwa kutsogolo kwa kutsogolo (komwe pamlingo wina kumafanana ndi kutalika kwa m'mphepete kutsogolo kwa chipinda chapamwamba pansi ndi "standard" yotalikirapo). Kutalika kokwezera kwa "standard" ndi 2.75 cm (ndi nsapato ya 10 (30) cm). Chizindikirochi chimatha kuyambira pa 2.25 (osachepera) mpaka 3.75 masentimita (chomaliza chimagwiritsidwa ntchito pachiwopsezo chachikulu, kuphatikiza ndi orthosis).

Njira zingapo zafotokozedwa zomwe zimawongolera zokongoletsa ndi malingaliro a nsapato ndi odwala (kuchepetsa kutalika kwa chidendene kuti muchepetse kukula kwake konse, etc.).

Infocking odziwitsa insole (polyurethane foam, plast-zas). Zopuma ndi / kapena zoyikirira za silicone mu insole ndizotheka muyerekezo wa mitu ya mafupa achitsulo.

Metatarsal khushoni (= kuthandizira kwa chopondera chopondera phazi = kukonza kwa flatfoot yopingasa) ndizotheka, koma mosamala komanso pokhapokha panjira zina zosamutsira katundu. Malinga ndi akatswiri, "Pogwiritsa ntchito chinsalu pamwamba pake, pilo yazitsulo ingagwiritsidwe ntchito ngati mukuyenda

("Kuchita zolondola") pamtambo wopingasa wa phazi (wotsimikizika ndi wamiseche pakamayesedwe). Mwa odwala ambiri omwe asintha zilonda zam'mimba zam'mphepete zam'matumbo, kutsitsa pamalopo popanda pilo yazitsulo sikungakhale kokwanira. " Siyenera kuyambitsa zovuta kwa wodwalayo, iyenera kupezeka molondola, kuwonjezeka kwapang'onopang'ono kutalika kwake ndikotheka. Tiyenera kukumbukira kuti kupindika kwa phazi kwa odwala omwe ali ndi SDS nthawi zambiri kulibe vuto.

Pali zida zoyamwa modabwitsa zomwe zimavala kumapazi (kuphatikizapo silicone), mitundu itatu yosiyanasiyana. Zitha kugwiritsidwa ntchito kuphatikiza ndi nsapato (koma nsapato ziyenera kukhala ndi malo owonjezera kwa izo). Akatswiri ena amakayikira kuthekera kwawo kwa wodwalayo (kuchuluka kwa odwala omwe amawavala nthawi zonse kumakhala kochepa).

2. Longitudinal flatfoot, kusintha kwa ulcerous (hyperkeratoses) pamtundu wa femararsophalangeal olowa.

Zolinga za nsapato: kusunthidwa katundu kuchokera kutsogolo-kwamkati mwa phazi mbali zammbali ndi kumbuyo.

Njira zokutsitsira magawo owopsa

Chithandizo (chakumapeto) kwa lingaliro lalitali la phazi,

Osakhazikika ndi mpukutu (onani. Mkuyu. 1),

Cushioning insole material (onani gawo 1).

3. Zingwe zoboola ngati nyundo komanso nyundo, zosintha zokhala pachilonda pamaso pake (pamwamba pa zala) komanso kumbuyo kwa malo olumikizirana mafupa nthawi zambiri zimaphatikizidwa ndi pelecanic flatfoot.

Ntchito za nsapato: I - ndimachepetsa katundu pamwamba pa zala; ndipo II - ndimachepetsa kuponderezedwa kwa nsapato kumbuyo komwe kwa zolumikizana zolumikizana.

Yankho I

Osakhazikika ndi mpukutu (amachepetsa katundu pachikopa chonse - onani pamwambapa),

Kuphwanya katundu wa insole (onani gawo 1),

Madotolo angapo amapereka mankhwala owongolera ndi chala (Gevol, Scholl, ndi zina) pofuna kutsitsa. Njirayi imavomerezeka ngati yovomerezeka (ngati chala chili cholondola, mosamala kwambiri, wodwalayo amalangizidwa komanso palibe kuchepa kwa chidwi), koma ndikofunikira kuchitapo kanthu kuti ayike nsapato poganizira kuvala kwa fixator. Makina ochitira kukonza, omwe amangiriridwa chala chachiwiri kapena chachitatu mothandizidwa ndi kuluka, amakhala otetezeka kwambiri kuposa zitsanzo za "silicone", pomwe chala chimayikidwa mu dzenje la chosakanizira.

Yankho II

Zowonjezera zapamwamba (foam latex ("kutambasula") mwanjira yokhazikitsira kumbuyo kwa zala kapena zikopa zofewa), kusowa kwa kapu yayitali. Kugwiritsira ntchito kwachikale kwa chala chakumaso (kumtunda kapena kutsogolo) mu nsapato zapakhomo kumakhazikika pa lingaliro la ngozi ya kuvulala kwa chala pakukhudza kutsogolo (komwe kumakhala kochepa kwambiri) ndi kapangidwe ka zikopa zachikopa kumtunda wa nsapato popanda chala chakumanja, chomwe chingavulaze kumbuyo kwa phazi. Njira yothetsera zovuta zamakolo: chopondera ndi chopukutira kuti muteteze phazi kumbuyo kwa zoyenda mukamayenda, chingwe cholimba chamkati mwa nsapatoyo (chimateteza phazi ndikuthandizira kuti nsapatoyo ikhale mawonekedwe), kukhazikika kwa okhawo (kumalepheretsa kuwerama kutsogolo kwa nsapato mukayenda).

4. Hallux valgus, kusintha kusanachitike zilonda m'dera la protruding ine metatarsophalangeal olowa ndi pamalo a zala za I ndi II moyang'anizana. Mwina kuphatikiza ndi kukhazikika kwa chala choyamba (Hyperkeratosis pa plantar padziko).

Zothetsera: nsapato za m'lifupi zokwanira, zapamwamba zopangidwa ndi zinthu zopepuka (zikopa zofewa, latex foam). Divdigital dividers (silicone) ndizotheka, koma pokhapokha ngati "kulondola" komwe kuli chala choyamba (chotsimikiziridwa ndi mayeso a udokotala).

Ndi kukhazikika kwa chala choyamba:

Osakhazikika ndi mpukutu (onani pamwambapa),

Chopweteka chomwe chimatenga mphamvu ya insole (onani gawo 1).

5. Kutenga kosinthidwa mkati mwa phazi, kudula kulikonse "kochepa" kumabweretsa kusintha kwakukulu mu biomechanics ya phazi, yomwe imawoneka powoneka pamtunda wa madera akuthamanga kwambiri, posunthika kwamalumikizidwe a phazi ndi chitukuko cha arthrosis, komanso kuwonjezeka kwa katundu kumapazi ena .

Kusintha kwawumbidwe wa chisanachitike zilonda zam'mimba zimatengera mtundu wamadulidwe. Mitundu ya kudulidwaku ndiyosiyanasiyana, zotsatirapo za zoyipa zosiyanasiyana zaphunziridwa mwatsatanetsatane ndi H. Schoenhaus, J. Garbalosa. Tikuyenera kudziwa zingapo za maphunziro apanyumba 1,2,12,13, potengera kafukufuku wazaka 4 komanso wazaka 4 za odwala omwe akudwala matenda a shuga omwe adadulidwa pang'ono. Mwanjira yofupikitsidwa, zazikulu zomwe zimadulidwa mkati mwa phazi zikuwonetsedwa pagome. Komabe, polingalira zakusiyana kwa njira yakudulidwira ndi zochita zina zingapo (mwachitsanzo, kupezeka kwa vuto la phazi musanalowerere), kuchuluka kwa zochuluka za zomwe

1 Kudzicheka pang'ono - kudula mkati mwa phazi, kudzicheka kwambiri - pamwamba pa gawo la cholumikizira (pamlingo wam'munsi kapena ntchafu).

Mavuto atadulidwa mkati mwa phazi

Mtundu wa zoyipa zovuta

1. Kutalikirana (kufalikira) kwa chala popanda kusinthanso ngati fupa la metatarsal (kumakhala ndi zotsatirapo zoopsa kwambiri kuposa kudula kwa chala ndi kufanana kwa mutu wamatenthedwe) • Kuyika mutu wopingasa mbali yam'mphepete mwa mapangidwe a mutu. Omwe atchulidwa kale ndi kusintha kwam'mbuyo kwa zilonda kumutu pakadula chala cha I kapena V • Kuyika zala zoyandikana kumbali ya yemwe palibe • Mukadulidwa kwa chala chaching'ono - chododometsa II.

2. Kudulidwa kwa chala chofanana ndi mutu wa metatarsal • II, III kapena IV zala zala • Ine kapena V zala • Zotsatira zake ndizochepa, koma pali zochulukitsa za mitu ya mafupa oyandikana nawo • Kuphwanya kapangidwe ka zopindika zazitali ndi zopingasa phazi (koma zovuta zoyipa zoterezi ndizochepa kuposa ndi kutanthauzira kosavuta kwa zala izi)

3. "Transverse resection" ya phazi (transmetatarsal, kudulidwamo kuphatikizika kwa Lisfranc kapena Chopard) • Kuchulukitsa ndi kuzunzika kwa chitsa chakunja ndi chitsa. Zomwe zimachitika ndi izi (motere): kusokonezeka kwa khungu m'dera la postoperative scar, kuvulala mpaka kumapazi ndi kumata kwa nsapato kapena nsapato zazingwe, kuchepa kwa gawo la chitsa, kuperewera kwa equinus, komanso kusunthika kwa phazi kutsogolo koyambirira mukamayenda nsapato zomwe sizigwira chakudyacho) • Zoduladula malingana ndi Shopar ndi Lisfranc - kutembenuka kwa phazi mkati kapena kunja (kutanthauzira)

kapena madera ena phazi likhoza kukhala losiyana, motero ndikofunika kuyendetsa pamanja kuti muzindikire madera omwe aphatikizidwa kwambiri. Mphamvu ya nsapato zamatumbo ndi insoles pamitundu yachilengedwe kwa odwala omwe adulidwa mkatikati mwa phazi idaphunziridwa ndi Mueller 15,16, malingaliro othandizira kupanga nsapato kutengera kutalika kwa chopondera phazi ndi ntchito ya odwala amaperekedwa ku Cavanagh 7,8.

Kuphatikiza pa izi, kudula “zazing'ono” kumapangitsanso kuti phazi la contralatial. Kuphatikiza apo, nsapato za phazi logwiridwira (choyambirira, pambuyo pokhapokha patadutsa pakati pa zala 4 kapena 5) zimasokonekera munjira inayake: chifukwa chokhotakhota chopindika cha nsapato yomwe ili kutsogolo kwa chitsa, mapangidwe am'munsi mwa nsapato amapangika omwe amavutitsa chitsa cham'mwamba.

Chochitika chapadera ndikudulidwa kwa gawo la chala (pamlingo wa wolumikizana wolumikizana). Mwinanso kukokana kwa chitsa pachala chotsatira, kumayambitsa zilonda pamwambo kapena chala choyandikana nacho. Komabe, vutoli limathetsedwa kwakukulukulu mwakuvala ma silicone ndi ma gaskets ofanana, m'malo mwa nsapato za orthopedic, chifukwa chake sichiwonedwe mwatsatanetsatane muzolemba izi.

Ntchito za nsapato zamadzimadzi mutadulidwa pang'ono zimakhala ndi zosiyana zingapo kuchokera kuntchito za nsapato za orthopedic zamagulu a shuga ambiri ndipo ndizotsatirazi.

1. Kutula zigawo zochulukitsa zomwe zikuwonekera pambuyo podulidwa pamtunda (zoneneratu

kukhazikitsa komwe kumatha kutengera deta ya patebulopo).

2. Kuchepetsa chiopsezo cha kuvulala kumbuyo kwa chitsa cha phazi (chifukwa chosinthika kwa zala mutadula ndi chifukwa cha kupangidwe kwa nsapato zapamwamba pachala chala).

3. Kukhazikika kwodalirika komanso kotetezeka kwa chitsa cha phazi, chomwe chimalepheretsa kutalikirana kwake mkati mwa nsapato mukayenda.

4. Kupewa kupunduka kwa phazi (kutheka pokhapokha koyambirira, kukonza kuwongolera ndi kowopsa komanso kosavomerezeka!): A) Kukhazikika kwa kumbuyo kwa phazi kuteteza kufooka (katchulidwe kapena katemera) - makamaka ndi stumps zazifupi (Lysfranc, Chopar works), b) ndi kusowa kwa mutu wa I kapena V metatarsal fupa - kupewa kutsekeka kwa miyendo ya phazi, c) ndi kufalikira kwa zala za II, III, kapena IV - kupewa kufalikira kwa mutu wamtundu wofananirako wamankhwala (kuphwanya kakhwalidwe kakakulu ka phazi), d) chimodzimodzi. schenie loyandikana zala motsogozedwa tchulani (iwo).

5. Kuchepetsa kupsinjika pazigawo zakumbali yakumaso.

Njira yothetsera mavutowa imatheka chifukwa cha nsapato zotsatirazi za nsapato.

1. Chokhazikika chokhazikika ndi mpukutu chofunikira ndikumasulidwa kwamanja, komanso kupewa kuteteza kwa kumtunda kwa nsapato.

2. Zilankhulo ziyenera kupangidwa molingana ndi mawonekedwe a miyendo ndikubwereza zopindika popanda kuyesa kuwongolera. Ngati cushioning katundu wa insole sangakwanitse kuchepetsa kupanikizika kwa magwiridwe anthaka, kuyika zofewa pansi pa magawo ofunikira kuyenera kuchulukitsa.

3. Kudzaza ma voids ofewa ndi zida zokutira m'malo m'malo osowa phazi. Pakakhala zala zilizonse, izi zimatheka povala "chala cham'manja" cha silicone ndikulepheretsa kuchoka kwa zala zoyandikira kupita kwa omwe palibe. Ndi magawo otalikirana phazi (kusowa kwa zala zonse), kudzaza kumalepheretsa kukwera kumtunda kwa nsapato ndikuletsa kupendekera kwamiyendo phazi mukamayenda. Izi zimatheka ndi kupendekera kosalala kutsogolo kwa insole. Ndi mbali yayitali ya phazi (kuduladula chala chimodzi kapena ziwiri mpaka zitatu zokhala ndi mafupa achitsulo), kudzaza ma voids kuli kowopsa (kumakulitsa chiopsezo). Funso lazofunikira ndi zopindulitsa zodzaza ma voids ndilotsimikizika ndikuwofufuzidwa bwino. Mu ntchito ya M. Mueller et al. adaphunzira mitundu yosiyanasiyana ya nsapato kwa odwala omwe ali ndi matenda ashuga atatha transmetatarsal resection phazi. Nsapato zazitali kutalika ndi okhazikika pokhapokha komanso kudzaza kutsogolo kunali kosavuta kwambiri komanso zovomerezeka kwa odwala. Monga njira ina, nsapato zazitali kutalika kwa phazi lolumikizidwa, nsapato zokhala ndi orthosis pamwendo wapansi ndi phazi (kuti muchepetse katundu pa chitsa) ndi nsapato zazitali kutalika osadzaza ma voids zimaganiziridwa. Kudzaza (malinga ngati zida zofewa zikugwiritsidwa ntchito ndipo chitsa chake chitaponyedwa) kumathandiza kuti phazi lisasunthike, koma kutsogolo kwa chitsa kumavulala. Chifukwa chake, chitsa chake chizikhala chokwanira kwambiri pakukwera nsapato kuposa ndikudzaza.

4. Chilankhulo cha nsapato za odwala omwe ali ndi masitepe oyenda pamapazi ayenera kukhala odulidwa, chifukwa Kupanda kutero, kudzimbidwa kolankhula ndi lilime kumapangitsanso zilonda zam'mimba zomwe zimayikidwa mu gawo la chitsa.

5. Ndi "chipembedzo chachifupi" (cholumikizira malingana ndi Lys-franc ndi Chopard), nsapato pamwamba pa chopondera pakhomo ndizofunikira kukonza phazi. Kuti muthe kuwonjezera chitsa mwa odwala, kukhazikika kwamalilime mwa nsapato ndikotheka (ndi chifuwa chofewa pamphepete). Njira ina yothetsera vutoli ndiyo valavu yolimbira ya insole (kuyambira pa kudzaza ndikudula) ndi chingwe chofewa pa chitsa. Popewa kutanthauzira / kuyamwa, odwalawa amafunika msana wolimba (ozungulira wozungulira), ndipo insole iyenera kukhala ndi chikho chozama cha calcaneal.

6. Ndi "kagulu kakang'ono" chifukwa chakuchepa kwamphamvu kwa phazi m'mbali komwekonso nkotheka

Zilonda pamtunda pamera pachitsa ngakhale kuti mukuyesetsa kuti muchepetse katundu ndi nsapato ndi insoles. Kuphatikiza apo, kusapezeka kwa phazi zambiri kumabweretsa zovuta zovuta poyenda. Pazinthu izi, kuphatikiza nsapato zokhala ndi ma prosthetic ndi mafupa a ziwonetsero zomwe zikuwonetsa gawo la katundu pa mwendo wotsika (orthosis pa chitsa cha phazi ndi mwendo wotsika womwe nsapato zake zimavalidwa, kapena nsapato zokhala ndi orthosis yam'munsi yophatikizidwa.

Malangizo olondola a opaleshoni amatha kuchepetsa zotsatirapo zoyipa zomwe zingachitike chifukwa chodulidwa pang'ono. Nthawi zina, chikhumbo chokhala ndi minofu yambiri yolimba imabweretsa kuti chitsa cha biomechanically chikhale cholakwika (mwachitsanzo ndikudulidwa kwa chala popanda kufufutidwa kwa mutu wachitsulo). Kuphatikiza apo, ndikukula kwa chitsa cha equinus chokhala ndi zilonda zam'mimbidwe kutsogolo kwa nthaka yake, kutalika kwa ma Achilles tendon (Tendo-Achilles lenthening, TAL) kungagwiritsidwe ntchito. Kuchita bwino kwa njirayi kwatsimikiziridwa mu maphunziro angapo a 3-5, 14-16. Njirayi imagwiranso ntchito polemba katundu patsogolo chifukwa cha kukoka kwambiri kwa Achilles tendon (osati pokhadzula pang'ono).

6. Diabetesic osteoarthropathy (OAP, Phazi la Charcot)

Kusintha kwasinthidwe musanafike zilonda zam'mimba zimatengera malo omwe pali zotupa ndi kuuma kwa mapindikidwewo. Phazi la Charcot - kuwonongeka kopanda mafupa ndi mafupa chifukwa cha matenda ashuga, amakhudza osakwana 1% ya odwala matenda ashuga (m'madipatimenti "a Diabetesic phazi" kuchuluka kwa odwala omwe ali ndi OA mpaka 10%). Ndikofunikira kusiyanitsa phazi la Charcot ku mafupa am'mapazi pafupipafupi, mafupa a mafupa a miyendo ndi chiwonongeko champhamvu cha minofu ya mafupa (osteomyelitis, nyamakazi ya purulent). Zofunikira za nsapato zamatumbo zomwe zimakhala ndi OAP zimasiyana kwambiri kutengera komwe kuli komanso gawo la ndondomekoyi.

Mitundu ya kutanthauzira kwa OAP. Amavomerezeka kuti agawike m'mitundu isanu.

Magawo a OAP (osavuta): pachimake (miyezi 6 kapena mtsogolo - popanda chithandizo pakhala kuwonongedwa kwathunthu kwa mafupa a kumapazi, chosakanikira chopangidwa, chiwopsezo chachikulu cha zilonda mukavala nsapato wamba). Mu gawo la pachimake, phazi lomwe lakhudzidwa limakhala ndi kutentha kokwezeka, kusiyana kwa kutentha (mukayezedwa ndi thermometer ya infrared) kupitilira 2 ° C. Chimodzi mwazofunikira kuti mumalize siteji yovuta kwambiri ndikusiyana kwa kutentha kwa miyendo yonse iwiri.

Chithandizo choyambirira - kutsitsa pogwiritsa ntchito Contact Cast kapena analogues - kumakuthandizani kuti muimitse njirayi moyenera, kuti muchepetse kupunduka kwa phazi. Mankhwala ndi ofunika kwambiri kuposa kutulutsa kwathunthu. Chifukwa chake, mu gawo loyipa (lomwe kwenikweni

Mkuyu. 8. Kusintha kwachitetezo cha OAP (gulu la Sanders, Frykberg) kuwonetsa pafupipafupi zowonongeka (zambiri).

I - metatarsophalangeal joints, II - kulumikizana kwamaso, III - mafupa amaso, IV - cholumikizira mafupa,

V - calcaneus.

imayimira mafupa angapo a mafupa kumapazi) wodwala safuna nsapato zamadzimadzi, koma woponyedwa ndi nsapato ataponyedwa, atachoka pachimodzimodzi, nsapato zamatumbo.

Zofunikira za nsapato / insoles zimatengera momwe zinthu zilili (onani pansipa). Nsapato zimafunika pachimodzimodzi, ngati pali phazi.

Kuvomerezera katundu mu OAP

• Kuletsedwa kwathunthu kuyesa kukonza vuto lakumapazi pogwiritsa ntchito mapilo azitsulo, m'chiuno, ndi zina.

• Pakasinthidwa phazi, phazi zizipangika payokha, kubwereza kupumula komwe kumera, kumanzere ndi kumanzere sikungafanane ndi asymmetry momwe mawonekedwe.

• Ngati kusinthaku kwachitika, makina oyimilira azikhala opanda chofewa, koma osakhala ofewa kwambiri (apo ayi pali chiopsezo chakuchoka kwazinthu zinafupa), kuuma kolimba kumakhala pafupifupi 40 ° gombe. Pakadali pano, kulowetsa zofewa, kupuma pansi pamalo opindika kwambiri mkati mwa phazi (makamaka ndi kusintha kwam'mbuyo kwa zilonda!), Malo ophatikizika amtundu wofewa amatha kuchepetsa katundu pamagawo awa.

Zochitika zosiyanasiyana zamankhwala odwala omwe ali ndi OAP

Palibe kusowa

A. Njira ya kudalilidwa kwina kulikonse, idayimilira koyambirira: madera omwe anali ndi mpunga

Palibe zilonda, koma ndikofunikira kuchepetsa kuyendayenda kwamalo oyanjana ndi mapazi poyenda kuti musapulumutse magawo a OAP. Kukonza: cholimba chokhazikika ndi cholembera, cholumikizira mobwerezabwereza chamiyendo chakumapazi, popanda kuyesa kukonza. Ankle thandizo kwa zotupa za ankalo.

Ndi zoperewera

B. Type I (metatarsophalangeal and interphalangeal joints): kuchepa komanso chiwopsezo cha zilonda ndizochepa. Nsapato: kuvula chovala chamtsogolo (yokulungira + zomwe zatchulidwazi pamwambapa za insoles za OAP).

B. Mitundu II ndi III (kulumikizana kwa tarsal-metatarsal and joars tarsal): Kulemala kwambiri (“kugwedeza pansi”) ndi chiopsezo chachikulu cha zilonda zapakati pa phazi. Zolinga za nsapato: kuchepetsa katundu pakatikati pa phazi + kuti muchepetse kuyenda koyenda kumapazi kwa phazi mukamayenda (izi zitha kuteteza kukula kwa mtundu wa "kugwedeza pansi"). Yankho: okhazikika pokhapokha ndi mpukutu. Mpukutu wakumbuyo ulipo kuti uthandizire kuyenda. Ma insoles (opangidwa molingana ndi malamulo omwe afotokozedwawo mosamala). Mwatsatanetsatane, onani zotsatira zanu pogwiritsa ntchito nsapato mkati mwa nsapato (Pedar, Diasled, etc.), ngati kuli kofunikira, sinthani zonyoza mpaka kukakamizidwa pamalo operekera ndizosakwana 500-700 kPa (mtengo wopangira zilonda2).

Ngati njira zomwe zafotokozedwazo sizokwanira (kuponderezedwa kumakhalabe kumtunda kwa chilonda mkati mwa phazi ngakhale mutavala nsapato kunyumba ndi kunja), kuphatikiza nsapato, gawo la katundu pa mwendo wotsika (orthosis pa mwendo ndi phazi) limatha kusamutsidwa. Malinga ndi Cavanagh (2001), Mueller (1997), nsapato zokhala ndi orthosis ndizothandiza kwambiri kuthetsa "zigawo zowopsa" pamapazi, koma kugwiritsidwa ntchito kwake ndizochepa chifukwa chovuta kwa wodwalayo.

G. Lembani IV (kuwonongeka kwa cholowa cha pachifuwa). Vuto: kusakanikirana kwapawiri (zilonda zam'maso) + kuwonongeka kowonjezereka, kupindika manja. Chithandizo: nsapato zomwe zimalepheretsa kupweteka kwa chidendene, kubwezeretsa kufupika kwa miyendo. Ngakhale akuyesera kuti apange nsapato yokhala ndi hard hard back and berets3 (koma ndi chingwe chofewa mkati), izi nthawi zambiri sizithetsa vuto lavulala.Ambiri mwa odwala amafunikira orthosis yokhazikika pamtunda wamphazi ndi phazi (ophatikizidwa kapena ophatikizidwa ndi nsapato).

Mu diabetesic osteoarthropathy, njira za opaleshoni zimagwiritsidwanso ntchito pochotsa zofooka 19,22,23 - resection of protruding fragments, arthrodesis, reposition

Malinga ndi kafukufuku wochitidwa ndi Hsi, 1993, Wolfe, 1991, kupsinjika kwakukulu kwa 500 kPa ndikokwanira kwa zilonda zam'mimba mwa odwala ena. Komabe, malinga ndi zotsatira za Armstrong, 1998, adaganiziridwa kuti athe kulingalira za mtengo wapadera wa 700 kPa chifukwa cha kuchuluka kwakukulu kwa zomverera komanso kutsimikizika pankhani iyi.

3 Zodandaula zokhazikika - gawo lapadera pakatikati pa nsapato yapamwamba kuti muchepetse kusunthira m'chiuno ndi m'malo ophatikizika, ophimba kumbuyo ndi mbali yakumapazi kwa phazi ndi m'munsi lachitatu la mwendo wotsika.

Zidutswa za mafupa ogwiritsa ntchito zida za Ilizarov, zomwe zimachepetsa chiopsezo cha zilonda zam'mimba ndikuthandizira kupanga nsapato. M'mbuyomu, kukhazikika mkati kapena arthrodesis kunali kogwiritsidwa ntchito makamaka (kufalikira kwa zidutswa ndi zomangira, mbale zachitsulo, ndi zina), tsopano njira yayikulu yokhazikitsira kuyikika ndi kukhazikitsidwa kwakunja (zida za Ilizarov). Chithandizo choterechi chimafuna kudziwa zambiri kwa dokotala wochita opaleshoni ndi ma transdisciplinary mogwirizana (madokotala, akatswiri a mbiri ya matenda ashuga a Diabetesic, Izi zikupangidwanso kuti muthane ndi zilonda zam'mimbamo, ngakhale munakonzedwa kwathunthu.

D. Mtundu V (ma calcaneus fractures) achilendo. Pakadali pano, ndikupanga kufooka, ndikofunika kulipiritsa kuti lifupikitse miyendo, ndikusamutsa gawo lina la katundu kumwendo wapansi.

7. Zofooka zina

Mitundu ina yachilendo kwambiri yopunduka imatheka, komanso kuphatikiza matenda ashuga ndi zotupa zina zam'munsi (kufupikitsa ndi kufooka chifukwa cha zovuta zopunduka, polio, ndi zina). Pazinthu izi, "matenda ashuga" a nsapato zamadzimadzi ayenera kuphatikizidwa ndi ma algorithms omwe amatengedwa m'malo ena a orthopedics ndi orthopedic shoe.

Chifukwa chake, kumvetsetsa kwamapangidwe amtundu wa biomechanical, kutengera zotsatira za maphunziro, kumakupatsani mwayi wopanga nsapato kwa wodwala wina wothandizadi popewa zilonda zam'mimba. Komabe, ntchito yambiri imayenera kuyikidwa kuti mudziwe izi.

1. Bregovsky VB et al. Zilonda za m'munsi zatsoka la shuga. St. Petersburg, 2004

2. Tsvetkova T.L., Lebedev V.V. / Katswiri wazithunzithunzi zoneneratu za chitukuko cha zilonda zam'mimba mwa odwala matenda a shuga. / Msonkhano Wadziko lonse wa St. Petersburg International "Regional Informatics - 2000", St. Petersburg, Disembala 5-8, 2000

3. Armstrong D., Petros E., Athanasiou K., Lavery L. / Kodi pali gawo lotsutsa la kuthamanga kwamapazi am'mapazi kuti muzindikire odwala omwe ali pachiwopsezo cha kupweteka kwamiyendo ya neuropathic? / J. Foot Ankle Surg., 1998, vol. 37, p. 303-307

4. Armstrong D., Stacpoole-Shea S., Nguyen H., Harkless L. / Kutalika kwa tendon ya Achilles mu odwala matenda ashuga omwe ali pachiwopsezo chachikulu cha zilonda zam'mapazi. / J Bone Joint Surg Am, 1999, vol. 81, p. 535-538

5. Barry D., Sabacinsky K., Habershaw G., Giurini J., Chrzan J. / Tendo Achilles wodwala matenda opatsirana odwala matenda ashuga omwe amadulidwa matendawa. / J Am Podiatr Med Assoc, 1993, vol. 83, p. 96-100

6. Bischof F., Meyerhoff C., Turk K. / Der diabetesische Fuss. Diagnose, Therapie und schuhtechnische Versorgung. Ein Leitfaden fur Orthopedic Schumacher. / Geislingen, Maurer Verlag, 2000

7. Cavanagh P., Ulbrecht J., Caputo G. / The biomechanics of the foot inabetes mellitus / Mu: The Diabetesic Foot, 6th edition. Mosby, 2001., p. 125-196

8. Cavanagh P., / nsapato kapena anthu odwala matenda ashuga (maphunziro). International Symposium "Diabetesic Phazi". Moscow, Juni 1-2, 2005

9. Coleman W. / Mpumulo wa zopinga zamkati zogwiritsa ntchito nsapato zakunja zokha. Mu: Patil K, Srinivasa H. (eds): Processings of the International Conference on Biomechanics and Clinical Kinesiology of Hand and Foot. Madras, India: India Institute of Technology, 1985, p. 29-31

10. Garbalosa J., Cavanagh P., Wu c. et al. / Phazi ntchito odwala matenda ashuga pambuyo ochepa kudulidwa. / Phazi Ankle Int, 1996, vol. 17, p. 43-48

11. Hsi W., Ulbrecht J., Perry J. et al. / Plantar anzanu atatsala pang'ono kulowa pachilonda pogwiritsa ntchito nsanja ya EMED SF. / Matenda a shuga, 1993, Suppl. 1, p. 103A

12. Lebedev V., katswiri wodziwika ndi Tsvetkova T. / Rule woneneratu za chiwopsezo cha zilonda zam'mimba kwa odwala matenda ashuga omwe akudula. / Msonkhano wa sayansi. Munich, Germany, 2-6 Aug 2000.

13. Lebedev V., Tsvetkova T., Bregovsky V. / Zaka zinayi zotsatizana ndi odwala matenda a shuga omwe akudula. / Msonkhano wa sayansi. Kananaskis, Canada, 31 Jul-3 Aug 2002.

14. Lin S, Lee T, Wapner K. / Plantar kutsogolo kwa zilonda zam'mimba za odwala omwe ali ndi matenda ashuga: momwe tendo-Achilles akukulira ndikukutana kwathunthu. / Ortopedics, 1996, vol. 19, p. 465-475

15. Mueller M., Sinacore D., Hastings M., Strube M., Johnson J. / Zotsatira za Achilles tendon zokulitsa zilonda zam'mimba za neuropathic. / J Bone Joint Surg, 2003, vol. 85-A, p. 1436-1445

16. Mueller M., Strube M., Allen B. / Therapyutic nsapato zitha kuchepetsa kukakamiza kwa odwala omwe ali ndi matenda ashuga ndikudulidwa kwa transmetatarsal. / Chisamaliro cha Mashuga, 1997, vol. 20, p. 637-641.

17. ntar yakutsogolo zamapazi. / J. Am. Podiatr. Med. Assoc., 1988, vol. 78, p. 455-460

18. Presch M. / Protekatives schuhwerk beim neuropathischen diabetesischen Fuss mit niedrigem und hohem Verletzungrisiko. / Med. Orth. Tech,

1999, vol. 119, p. 62-66.

19. Resch S. / Corrective opaleshoni yodwala matenda ashuga. / Diabetes Metabolism Research and Reviews, 2000, vol. 20 (suppl. 1), p. S34-S36.

20. Sanders L., Frykberg R. / Diabetesic neuropathic osteoartropathy: Chaocot foot./In: Frykberg R. (Mkonzi.): Phazi la chiwopsezo cha matenda a shuga. New York, Churchill Livingstone, 1991

21. Schoenhaus H., Wernick E. Cohen R. Biomechanics wa phazi la matenda ashuga.

Mu: Phazi lalikulu kwambiri la matenda a shuga. Mkonzi. Wolemba Frykberg R.G. NewYork, Churchill Livingstone, 1991

22. Simon S., Tejwani S., Wilson D., Santner T., Denniston N. / Arthrodesis ngati njira ina yoyambirira yosagwirizana ndi oyang'anira a Chacot arthropathy a phazi la matenda ashuga. / J Bone Joint Surg Am, 2000, vol. 82-A, Ayi. 7, p. 939-950

23. Mwala N, Daniels T. / Midfoot ndi hindfoot arthrodesis mu matenda a shuga a Charcot arthropathy. / Kodi J Surg, 2000, vol. 43, Ayi. 6, p. 419-455

24. Tisdel C., Marcus R., Heiple K. / triple arthrodesis wa matenda a shuga a peritalar neuroarthropathy. / Phazi Ankle Int, 1995, vol. 16, Ayi. 6, p. 332-338

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Zofunikira zoyambirira za nsapato zamatumbo a shuga

Cholinga chachikulu cha nsapato zamatumbo kwa odwala omwe ali ndi matenda a shuga (DM) ndikupewa matenda ashuga othamanga (DIABETIC STOP SYNDROME).

DIABETIC FOOT SYNDROME - izi zimalumikizidwa ndi mitsempha ya mitsempha (diabetesic neuropathy, Charcot) ndi vuto la mtima (diabetesic angiopathy), kuwonongeka kwa minofu yapamwamba komanso yakuya kwambiri kwa phazi.
DIABETIC FOOT SYNDROME imawonetsedwa ndi zilonda zamkati zosachiritsa, chiwonongeko ndi kufa kwa minofu, zomwe zimakhala zovuta kuthana ndi matenda opatsirana.
DIABETIC FOOT SYNDROME, mwatsoka, nthawi zambiri zimatha ndi gangrene komanso kudula.

Khungu la miyendo yokhala ndi matenda a shuga (10-20% ya odwala matenda ashuga) limadulidwa, lakhala pachiwopsezo, pali kuchiritsidwa kwakanthawi kwa mabala ang'ono, mabala, zilonda zam'mimba. Kuuma, kusenda komanso kuyabwa ndizomwe zimapangitsa kuti pakhale zotupa komanso matenda. Ndi venousion, thrombosis, thrombophlebitis, kulephera kwa mtima, kutupa ndi cyanosis. Edema ya subcutaneous minofu ndi yosagwirizana, m'malo ochepera khungu minofu kusinthika, limatchulidwa.
Mu diabetesic neuropathy (30-60% ya odwala), zowawa, zopanda pake komanso kutentha kwa mapazi kumapazi. Odwala nthawi zambiri samazindikira mawonekedwe a ming'alu, ma callus, scuffs ndi kuvulala pang'ono, samamva kuti nsapato zimakanikizira kapena kuvulaza phazi.
Mitundu yapadera ya matenda a shuga a shuga imayambitsa matenda a osteoarthropathy (OAP) (phazi la Charcot) - mafupa a phazi amakhala osalimba, osatha kupirira kupsinjika kwakanthawi tsiku ndi tsiku, kugwa kwamayendedwe pomwe mukuyenda, microtrauma imatha kuchitika.

Chifukwa chake, odwala ambiri omwe ali ndi matenda ashuga amawonetsedwa nsapato zapadera, zomwe zimatha kutsirizika kapena kusoka pa chipika cha munthu.
Nsapato zomwe zimapangidwa molingana ndi chipika chapamwamba zimawonekera pokhapokha pakuwonongeka kwakukulu kwa phazi, kukula kwake sikokwanira popanda kukakamizidwa muyezo wa chipika chokhazikika, poganizira kukwana kwawo komanso kulola kwawo.
Nsapato zopangidwa molingana ndi nsapato ya amodzi amagwiritsidwa ntchito pamaso pa zopunduka, kapena ngati kukula kwa phazi sikulowa muyezo.

Kusintha kwa mapazi mwa odwala omwe ali ndi matenda a shuga amathanso kukhala okhudzana ndi matenda a shuga (matenda a Charcot - diabetesic osteoarthropathy) ndikusintha kuduladula, kapena kosagwirizana - kukomoka kwa chala chakumaso (Hallux Valgus), kusinthasintha kwa nkhope yamanja metatarsal mitu, varus kuwonongeka kwa chala chaching'ono (Taylor deformity), varus kapena valgus kukhazikitsa pakati ndi chidendene mbali ya phazi, nsapato zolowa, kutalika kwamtunda kwa phazi (kotenga nthawi yayitali phazi lathyathyathya, phazi la valgus), etc.

Kusintha kwadzeru ndi kupunduka kwamapazi kumayambitsa kugawa kosayenera, mawonekedwe amtundu wambiri, komwe zimasinthidwa mwanjira yovomerezeka komanso mosagwirizana ndi magazi.
Chifukwa chake, pakupanga kwa insole, kwa odwala omwe ali ndi matenda osokoneza bongo, zofunikira zamatsenga ziyenera kuyikidwira kuti ikonzedwe ndikuwongolera kwa pathological ndi kutsitsa kwa zofooka, ndikugawa yunifolomu kumapazi.
Popeza kupunduka ndi kusanjika kumakhala kwa wodwala aliyense, zophatikizira zamkati (ma insoles) ziyenera kukhala zokhazokha, kubwereza phazi, molingana ndi kusintha kulikonse.
Malo omwe pali kusintha kwa zilonda zam'mbuyo monga ma hyperkeratoses omwe ali ndi zotupa, ma hyperkeratoses ofunda pamtunda wa chomera, cyanosis ndi hyperemia ya pakhungu pamiyendo ya phazi ayenera kutsitsidwa mosamala.
Zipangizo zolumikizana ndi phazi ziyenera kukhala zofewa komanso zotanuka, kuyamwa zotupa ndi zotumphukira za phazi, insole iyenera kukhala yopyapyala komanso yofewa. Mukadula zingwe za nsapato, ndikofunikira kugwiritsa ntchito matekinoloje osatulutsa, kapena kuwerengera malo omwe msoko uli m'malo omwe kulumikizana pakati pa phazi ndi phazi komanso mwayi wopukusira ndizochepa. Ma voliyumu amkati ndi kumatula ziyenera kukhala zokwanira, kwinaku mukukhazikika bwino kukonza nsapato pamapazi kuti musavulazidwe ndikupukutira.

Hypoallergenicity ya zinthu zomwe zimagwiritsidwa ntchito ndizofunikira kwambiri. Kupezeka kwa ziwopsezo zotupa kumakhudzanso thanzi la minofu ndipo ndikulimbikitsa kwa matenda.
Pofuna kuteteza ku kuvulala komanso kukopa kwakunja kwa nsapato, kwa odwala omwe ali ndi matenda a shuga, ndikofunikira kugwiritsa ntchito zinthu zolimba, zododometsa, ndikofunikira kupangira zinthu zolimba zosagwirizana ndi phazi.
Kugwiritsa ntchito kachipewa kakang'ono mu nsapato zamatumbo kumalumikizidwa ndi lingaliro lopewa kuwombera mwachindunji ndikupanga makola am'munsi mwa nsapato, omwe amatha kuvulaza kumbuyo kwa phazi. Chovala chala, kuti muteteze kuvulala ndikusunga mawonekedwe a nsapato, sayenera kulumikizana ndi zimakhala za phazi ndipo ziyenera kupezeka kutsogolo kwa nsapato (monga bumper) .Kupewa kuthana ndi kutsogolo, gawo lokha lingakhale ndi kukulitsa pang'ono komanso kutsekeka. Kugwiritsa ntchito zida zatsopano zokhala kumtunda ndi nsapato yolumikizira komanso yolimba yokhayo yomwe imalepheretsa kuwerama kutsogolo kwanu mukamayenda kumalepheretsa mapangidwe.
Mtambo wa nsapato uzikhala wofewa, paliponse, kupsinjika kwa iwo kuyenera kugawidwa pamalo akulu.

Mu diabetesic neuropathy, tactile ndi chidwi cha miyendo imavutika, kulumikizana kwamayendedwe kumathina, kukhazikika komanso kuthekera kosasamala kumachepa. Mtundu wokha wa nsapato zamafupa kwa odwala matenda ashuga ayenera kukhala otsika kwambiri, mulifupi, kupereka chithandizo chochuluka komanso kukhazikika.

Nsapato zapadera zomwe zimaganizira kukula kwa miyendo, kuchepa kwawo, kuopsa kwa matenda ashuga, chisamaliro choyenera komanso chapanthawi yake, komanso malingaliro a dokotala omwe akupezekapo atha kuchepetsa mwayi wokhala ndi matenda opatsirana a matenda ashuga ndi katatu.

Zinthu zonse zomwe zili pamwambazi komanso mawonekedwe zimatengedwa popanga nsapato za amisala ku Perseus Orthopedic Center.

Mayankho a Persia a odwala matenda a shuga amatha kupezeka pano.

Matenda a matenda ashuga

Zomwe zimayambitsa zovuta m'miyendo ndi:

1. Matenda a metabolism mu minofu, kufotokozera kwa cholesterol plaque mu ziwiya - kukula kwa atherosulinosis, varicose mitsempha.
2. Kuchuluka kwa shuga wamagazi - hyperglycemia - kumabweretsa kusintha kwamatenda am'mapeto a mitsempha, kukulitsa kwa neuropathy. Kutsika kwa kapangidwe kake kumayambitsa kukhumudwa kwam'munsi, kumavulala kwambiri.

Kwa odwala omwe ali ndi matenda ashuga, ma pathologies a zotumphukira zamagetsi amadziwika.

Zizindikiro za kuwonongeka kwa mwendo ndi:

• chepetsa kutentha, kuzizira,
• kuchuluka kwa khungu,
• kusintha kwamitundu
• kulemera kosalekeza, kumva kupsinjika,
• kusazindikira ululu, kukakamiza,
• kutupa
• kutaya tsitsi.

Kuchepa kwa magazi kumayambitsa mabala ambiri, kulumikizana ndi matenda. Kuchokera kuvulala kochepa kwambiri, kutupa kwamadzimadzi kumayamba, komwe kumatha nthawi yayitali. Khungu limakonda kupola zilonda, zomwe zingayambitse gangore.

Kusamva bwino kwakanthawi nthawi zambiri kumayambitsa mafupa ang'onoang'ono phazi, odwala amapitilizabe kuyenda osazindikira. Phazi limakhala lopindika, limakhala chosasinthika. Matenda a miyendo imeneyi amatchedwa phazi la matenda ashuga.

Pofuna kupewa matenda osokoneza bongo komanso kuduladula, wodwala matenda ashuga amayenera kupita ku maphunziro othandizira, olimbitsa thupi, ndikuwongolera shuga. Kuwongolera momwe miyendo imathandizira nsapato zosankhika zamkati.

Makhalidwe a nsapato zapadera

Ma endocrinologists, chifukwa chazaka zambiri zowonera, anali otsimikiza kuti kuvala nsapato zapadera sikuti kumangothandiza odwala kuyenda mosavuta. Amachepetsa kuvulala, zilonda zam'mimba ndi kuchuluka kwa kulumala.

Kuti mukwaniritse zofunikira zotetezeka komanso zopepuka, nsapato za zilonda zowawa ziyenera kukhala ndi izi:

1. Osakhala ndi chala cholimba. M'malo poteteza zala ku mabala, mphuno yolimba imapanga mwayi wowonjezera, kufinya, komanso kupewa magazi. Ntchito yayikulu ya mphuno yolimba mu nsapato kwenikweni ndikukulitsa moyo wautumiki, osati kuteteza phazi. Anthu odwala matenda ashuga sayenera kuvala nsapato zotseguka, ndipo chala chofewa chimapereka chitetezo chokwanira.
2. Musakhale ndi zotupa zamkati zomwe zingavulaze khungu.
3. Ngati kuli kofunikira kugwiritsa ntchito insoles, nsapato zazikulu ndi nsapato ndizofunikira. Izi ziyenera kuganiziridwa pogula.
4. Yokha yolimba ndi gawo lofunikira la nsapato yoyenera. Ndiye amene adzateteza ku misewu yamavuto, miyala. Mtundu wofewa wokhawokha sukusankha wodwala matenda ashuga. Kuti muteteze, malo okhazikika ayenera kusankhidwa. Kugwiritsa ntchito bwino mukamayenda kumakhala ndi ma bend.
5. Kusankha kukula koyenera - kupatuka mbali zonse (kukula kocheperako kapena kokulirapo) sikovomerezeka.
6. Zida zabwino ndiye zikopa zenizeni. Ndimalola kuti pakhale mpweya wabwino, kuti muchepetse zotumphukira ndi matenda.
7. Sinthani voliyumu masana ndi kuvala kwakutali. Imafikiridwa ndi ma clamp apafupi.
8. Dongosolo lolondola la chidendene (chingwe cha m'mphepete mwa kutsogolo) kapena cholimba chokhazikika ndi kukwera pang'ono kumathandiza kupewa kugwa komanso kupewa kupindika.

Kuvala nsapato zokhazikika, zopangidwa osati ndi anthu, zimawonetsedwa kwa odwala omwe alibe zofooka komanso zilonda zam'mimba. Itha kupezedwa ndi wodwala wokhala ndi kukula kwabwino kwa phazi, chidzalo popanda zovuta zazikulu.

Ngati ndi kotheka, mawonekedwe a miyendo amatha kusinthidwa payokha ndikupanga insoles. Pogula, muyenera kuganizira voliyumu yowonjezera kwa iwo.

Nsapato za phazi la matenda ashuga (Charcot) zimachitidwa ndi miyezo yapadera ndipo zimaganiziratu zoperewera zonse, makamaka miyendo. Pankhaniyi, kuvala zovomerezeka ndizosatheka komanso zowopsa, ndiye muyenera kulamula nsapato payokha.

Malamulo osankhidwa

Pofuna kuti musalakwitsa posankha, muyenera kutsatira malamulo otsatirawa:

1. Ndikwabwino kuti mugule chakumapeto, phazi likatupa momwe mungathere.
2. Muyenera kuyeza poyimirira, mutakhala, mukuyeneranso kuyendayenda kuti mumvetse kuthokoza.
3. Musanapite ku malo ogulitsira, zungulirani phazi ndikukhala ndi chidule. Ikani izi mu nsapato, ngati pepalalo limakutidwa, chosindikizacho chimakanikizira ndikusisita mapazi.
4. Ngati pali insoles, muyenera kuyeza nsapatozo nawo.

Ngati nsapatozo zinali zazing'ono, simungathe kuzivala, muyenera kungosintha. Simuyenera kupita nthawi yayitali mu nsapato zatsopano, maola 2-3 ndi okwanira kuti ayang'anire mawonekedwe ake.

Kanema kuchokera kwa katswiri:

Zosiyanasiyana

Opanga amapanga zinthu zingapo zomwe zimathandiza odwala omwe ali ndi matenda osokoneza bongo kuti azitha kuyendetsa ndi kuteteza miyendo yawo ku zowawa.

Mu mzere wa mitundu yamakampani ambiri pali mitundu iyi ya nsapato:

• ofesi:
• masewera
• ndi ana
• nyengo - chilimwe, chisanu, nyengo ya demi,
• homuweki.

Mitundu yambiri imapangidwa mu kalembedwe ka unisex, ndiko kuti, koyenera amuna ndi akazi.

Madokotala amalangiza kuvala nsapato zamankhwala kunyumba, odwala ambiri amakhala nthawi yayitali tsiku limenelo ndipo amavulala pamafinya.

Kusankhidwa kwa mtundu wofunikira kumapangidwa malinga ndi kuchuluka kwa kusintha kwa phazi.

Odwala agawidwa m'magulu awa:

1. Gawo loyamba limaphatikizapo pafupifupi theka la odwala omwe amangofunika nsapato zapamwamba zopangidwa ndi zinthu zabwino, zokhala ndi mafupa, popanda zofuna za munthu, zokhala ndi insole yodziwika bwino.
2. Lachiwiri - pafupifupi gawo limodzi mwa magawo asanu a odwala omwe ali ndi vuto lofooka, phazi lathyathyathya komanso wolumikizira payekha, koma woyenera.
3. Gulu lachitatu la odwala (10%) ali ndi zovuta zazikulu za phazi la matenda ashuga, zilonda, kudulidwa kwa chala. Amapangidwa ndi dongosolo lapadera.
4. Gawo ili la odwala limafunikira zida zapadera zoyendetsera munthu, zomwe, atatha kusintha momwe phazi limasinthidwira ndi nsapato za gulu lachitatu.

Kumasulira nsapato zopangidwa malinga ndi zofunikira zonse za orthopedists:

• gawani katunduyu pamapazi,
• Tetezani kuzisonkhezero zakunja,
• Osatupa khungu
• Ndikotheka kuvula ndikuvala.

Nsapato zabwino za odwala matenda ashuga amapangidwa ndi Comfortable (Germany), Sursil Orto (Russia), Orthotitan (Germany) ndi ena. Makampaniwa amapanganso zinthu zokhudzana - insoles, orthoses, masokosi, mafuta.

Ndikofunikanso kusamalira nsapato, kutsuka, kuuma. Muyenera kuchitira pafupipafupi ma antiseptic agents kuti muchepetse matenda a pakhungu ndi misomali yokhala ndi bowa. Mycosis nthawi zambiri amakula mwa odwala matenda ashuga.

Mitundu yamakono yokongola yamakono imapangidwa ndi opanga ambiri. Osanyalanyaza njira yodalirika yophunzitsira kuyenda. Izi ndizokwera mtengo, koma zithandiza kukhala ndi miyendo yathanzi ndikukonza moyo wabwino.