The effect of diabetic neuropathy on foot bones: a systematic review and meta‐analysis

Barwick, Alex; Jonge, X. Janse de; Tessier, John; Ho, Alan; Chuter, Vivienne

doi:10.1111/dme.12347

Cited by 12 publications

(5 citation statements)

References 33 publications

(107 reference statements)

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“…Several studies have demonstrated a reduction in calcaneal bone density assessed by ultrasound in association with the presence of peripheral sensory neuropathy (Conti et al, 2010;Rix, Andreassen, & Eskildsen, 1999;Sieradzki, Trznadel-Morawska, & Olszanecki, 1995). However, more recent studies have not reproduced this relationship (Barbaro, Orsini, Lapi, Turco, & Pasquini, 2008;Chakrabarty et al, 2004;Christensen, Bulow, Simonsen, Holstein, & Svendsen, 2010), and meta-analysis of existing data does not support such an association (Barwick et al, 2014).…”

Section: Discussionmentioning

confidence: 97%

“…Previous studies examining the relationship between neuropathy and the development of Charcot foot are inconclusive (Barwick et al, 2014). Several studies have demonstrated a reduction in calcaneal bone density assessed by ultrasound in association with the presence of peripheral sensory neuropathy (Conti et al, 2010;Rix, Andreassen, & Eskildsen, 1999;Sieradzki, Trznadel-Morawska, & Olszanecki, 1995).…”

Section: Discussionmentioning

confidence: 99%

“…Metaanalysis of available data demonstrated that, in the calcaneus of those with diabetes, there is a trend towards poorer bone health in those with neuropathy; however this failed to reach statistical significance (Barwick, Janse de Jonge, Tessier, Ho, & Chuter, 2014). The research to date is limited by a lack of available techniques to image foot bones and has so far mainly focused on the calcaneus.…”

Section: Introductionmentioning

confidence: 99%

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Foot bone density in diabetes may be unaffected by the presence of neuropathy

Barwick

Tessier

Jonge³

et al. 2016

Journal of Diabetes and its Complications

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Foot bone density in diabetes may be unaffected by the presence of neuropathy

Barwick

Tessier

Jonge³

et al. 2016

Journal of Diabetes and its Complications

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“…Final group allocation was based on the average of bilateral VPT with peripheral neuropathy defined at or above 25 V. The threshold of 25 V is commonly used in clinical studies to indicate high risk of foot ulceration [ 16 ], and a VPT above this threshold is abnormal irrespective of age [ 17 ]. The sample size was set at 20 participants per group based on previous similar studies [ 18 ]; however, ultimately the COVID-19 pandemic hindered recruitment.…”

Section: Methodsmentioning

confidence: 99%

Contribution of peripheral neuropathy to poor bone health in the feet of people with type 2 diabetes mellitus

2021

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Aims To evaluate the impact of peripheral neuropathy on bone health in people with type 2 diabetes mellitus (T2DM). Methods Participants with T2DM were grouped according to the presence of peripheral neuropathy as assessed by vibration perception threshold (VPT). Recruitment ensured groups were balanced for age, sex and body mass index (BMI). Bone health was measured by calcaneal quantitative ultrasound (QUS) and compared between groups. Calcaneal QUS parameters were correlated across the cohort with VPT and other prespecified variables. Results Thirty-four participants (17 per group) were included with mean age 68 ± 12 years, 47% male, with median BMI 29.9 (IQR 26.9–32.7) kg/m 2 . The peripheral neuropathy group had significantly lower mean Stiffness Index (87 ± 12 versus 101 ± 16, p = 0.01), Speed of Sound (1542 ± 28 versus 1574 ± 34 m/s, p < 0.01), and a trend towards lower Broadband Ultrasound Attenuation (113 ± 10 versus 120 ± 12 dB/MHz, p = 0.07). Pedal bone health asymmetry was not a significant feature in those with peripheral neuropathy. All calcaneal QUS parameters correlated negatively with VPT, although significance of the relationship with Broadband Ultrasound Attenuation was nullified if controlled for diabetes duration or time on insulin. Broadband Ultrasound Attenuation showed independent negative correlation with diabetes duration. Conclusions People with T2DM and peripheral neuropathy have poorer bone health as measured by calcaneal QUS than those without peripheral neuropathy, independent of age, sex and BMI.

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“…It is well known that endothelial nitric oxide and other endothelium-derived agents such as prostaglandins and endothelium-derived hyperpolarising factors play a role in the mechanism of PORH [63]. Apart from these substances, the sensory nerves contribute to the PORH mechanism, which makes this test suitable to assess neurovascular responses [20,[62][63][64][65][66][67]. The test involves recording a baseline reading, followed by an occlusion using supra systolic pressure (~180 to 220 mmHg) for a certain period and release of pressure.…”

Section: Post-occlusive Reactive Hyperemiamentioning

confidence: 99%

Cutaneous Microcirculation of the Foot

Victoria Balasubramanian,

Naemi

2023

Microcirculation - Updates in the Next Frontier of Vascular Disease

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The skin, the body’s largest organ, acts as a shield against infections and injuries. The skin has an inherent ability to autoregulate its blood flow, which depends on extrinsic/intrinsic factors. This function is facilitated by a complex regulatory system that includes local regulation of cutanemicrocirculation involving sensory and autonomic fibres. These play important roles in thermoregulation, maintenance of homeostasis, defence, inflammatory response and nutrition. Any structural or functional damage to the microvasculature can lead to an incongruity in the demand and supply either due to physiological or pathological reasons. Besides, the small fibre nerves supplied by the microvessels can suffer from hypoxia, which in turn can cause problems. By understanding these functional aspects and applying this knowledge for assessment, the complex pathophysiological mechanisms of diseases like Raynaud’s and diabetic-foot complications can be better understood. Moreover, microcirculation is crucial for wound healing in both diabetic foot and in pressure ulcers. This chapter aims to discuss the anatomy and physiology of foot microcirculation and its involvement in the pathobiology of certain diseases. Furthermore, various microcirculatory assessment tools and methods are discussed. Acquiring this knowledge can be helpful in providing more effective prevention, diagnosis, and treatment of microcirculatory diseases of the foot.

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The effect of diabetic neuropathy on foot bones: a systematic review and meta‐analysis

Abstract: We did not find a significant relationship between presence of neuropathy in those with diabetes and poorer peripheral bone health. However, methodological limitations of the included studies mean further research is required to investigate this theoretical relationship.

Cited by 12 publications

References 33 publications

Foot bone density in diabetes may be unaffected by the presence of neuropathy

Foot bone density in diabetes may be unaffected by the presence of neuropathy

Contribution of peripheral neuropathy to poor bone health in the feet of people with type 2 diabetes mellitus

Cutaneous Microcirculation of the Foot

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