Painful Neuropathy and Foot Ulceration in Diabetic Patients

Veves, Aristidis; Manes, Christos; Murray, Heather J.; Young, Matthew J.; Boulton, Andrew J.M.

doi:10.2337/diacare.16.8.1187

Cited by 87 publications

(65 citation statements)

References 7 publications

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“…First, we used a modified neuropathy symptom score (NSS) 17,18 and a modified neuropathy disability score (NDS) based on four parameters, 19,20 applying the following methods. Peripheral neuropathy was assessed with vibration perception threshold using a 128-Hz Rydel-Seiffer tuning fork.…”

Section: Clinical Neuropathy Testingmentioning

confidence: 99%

Marked loss of sympathetic nerve fibers in chronic Charcot foot of diabetic origin compared to ankle joint osteoarthritis

Koeck

Bobrik

Faßold

et al. 2009

Journal Orthopaedic Research

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The pathogenesis of Charcot foot is based on three disputed factors: (1) loss of neurotrophic influence, (2) microtraumatic lesions, and (3) neurovascular disturbances. These etiological causes were uncovered by clinicophysiological tests. However, no results of quantitative nerve density studies of sympathetic and sensory substance P-positive (SPþ) nerve fibers are available. We studied the density of sympathetic and SPþ nerve fibers in three distinct areas of the tarsus. Fifteen patients with ankle osteoarthritis (OA) and 15 patients with diabetic Charcot foot were included. Patients with OA did not differ from those with Charcot foot in SPþ sensory nerve fiber density. However, at all three areas, the density of sympathetic nerve fibers was significantly lower in patients with Charcot foot compared to OA (p ¼ 0.006). In addition, we found that the sympathetic nerve repellent factor semaphorin 3C was highly expressed in inflamed tissue in Charcot patients. In Charcot foot of diabetic origin a severe loss of sympathetic nerve fibers was observed. These findings in chronically inflamed Charcot foot lend support to the neurovascular theory in the late chronic phase, which probably depends on the inflammatory upregulation of nerve repellent factors. ß

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Section: Clinical Neuropathy Testingmentioning

confidence: 99%

Marked loss of sympathetic nerve fibers in chronic Charcot foot of diabetic origin compared to ankle joint osteoarthritis

Koeck

Bobrik

Faßold

et al. 2009

Journal Orthopaedic Research

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“…2,3 L'association aux complications micro et macroangiopathiques du diabète est à l'origine de maux perforants plantaires, responsables de douleurs chroniques, neuropathiques ou par excès de nociception. Ces douleurs retentissent significativement sur la qualité de vie des patients.…”

Section: Introductionunclassified

Cathéters sciatiques: une alternative analgésique chez les patients diabétiques

Schaeffer

Saché

Bourron

et al. 2015

Can J Anesth/J Can Anesth

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“…In our opinion, diagnostic tests should fulfill the following criteria: validation (presence of an independent reference standard, adequate spectrum and number of patients, standardization, soundly based item selection), predictive value, manageability (reproducibility, performance in clinical practice), and hierarchy. Frequently used and accepted examination scores for diabetic neuropathy are the Neuropathy Disability Score (NDS) (4), the Neuropathy Impairment Score in the Lower Limbs (NIS-LL) (5,6), various modified NDS scores (7,8), the Neuropathy Deficit Score (9), the Michigan Neuropathy Screening Instrument (MNSI) (10), and the Clinical Examination Score of Valk (CE-V) (11).…”

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confidence: 99%

“…The NIS-LL has not been validated. Various other modified NDS scoring systems have been used, such as those of Veves et al (7) and Young et al (8); however, these instruments also have not been validated, and no information is available on their predictive value regarding the results of clinical standards. The Neuropathy Deficit Score is a neurological examination score aimed at anatomical levels in the legs and arms (9).…”

mentioning

confidence: 99%

“…The Neuropathy Deficit Score is a neurological examination score aimed at anatomical levels in the legs and arms (9). It has not been validated, and no information is available about how to interpret modifications, which is also the case for the other modified NDS scoring systems (7,8). Feldman et al (10) developed a combination of 2 scoring systems: the MNSI (symptom and examination score) and the Michigan Diabetic Neuropathy Score (neurological examination and nerve conduction studies).…”

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confidence: 99%

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Diabetic neuropathy examination: a hierarchical scoring system to diagnose distal polyneuropathy in diabetes.

et al. 2000

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A hierarchical scoring system to diagnose distal polyneuropathy in diabetes OBJECTIVE -Existing physical examination scoring systems for distal diabetic polyneuropathy (PNP) do not fulfill all of the following criteria: validity, manageability, predictive value, and hierarchy. The aim of this study was to adapt the Neuropathy Disability Score (NDS) to diagnose PNP in diabetes so that it fulfills these criteria.RESEARCH DESIGN AND METHODS -A total of 73 patients with diabetes were examined with the NDS. Monofilaments and biothesiometry were used as clinical standards for PNP to modify the NDS.RESULTS -A total of 43 men and 30 women were studied; mean duration of diabetes was 15 years (1-43), and mean age was 57 years (19-90). A total of 24 patients had type 1 diabetes, and 49 patients had type 2 diabetes. Clinically relevant items were selected from the original 35 NDS items (specific item scored positive in Ͼ3 patients). The resulting 8-item Diabetic Neuropathy Examination (DNE) score could accurately predict the results of the clinical standards and is strongly hierarchical (H value 0.53). The sensitivity and specificity of the DNE at a cutoff level of 3 to 4 were 0.96 and 0.51 for abnormal monofilament scores, respectively. For abnormal vibration perception threshold scores, these values were 0.97 and 0.59, respectively. Reproducibility as assessed by inter-and intrarater agreement was good.CONCLUSIONS -The DNE is a sensitive and well-validated hierarchical scoring system that is fast and easy to perform in clinical practice.

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Painful Neuropathy and Foot Ulceration in Diabetic Patients

Cited by 87 publications

References 7 publications

Marked loss of sympathetic nerve fibers in chronic Charcot foot of diabetic origin compared to ankle joint osteoarthritis

Marked loss of sympathetic nerve fibers in chronic Charcot foot of diabetic origin compared to ankle joint osteoarthritis

Cathéters sciatiques: une alternative analgésique chez les patients diabétiques

Diabetic neuropathy examination: a hierarchical scoring system to diagnose distal polyneuropathy in diabetes.

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