Asymmetrical attenuation of vibration sensation in unilateral diabetic Charcot foot neuroarthropathy

• Published in: Diabetic medicine Vol. 29; no. 9; pp. 1191 - 1194
• Main Authors: Valabhji, J., Marshall, R. C., Lyons, S., Bloomfield, L., Hogg, D., Rosenfeld, P., Gabriel, C. M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2012; Blackwell
• Subjects: Adult; Biological and medical sciences; Charcot; Cohort Studies; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - physiopathology; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - physiopathology; Diabetes. Impaired glucose tolerance; diabetic foot; Diabetic Foot - etiology; Diabetic Foot - physiopathology; Diabetic Neuropathies - etiology; Diabetic Neuropathies - physiopathology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Feeding. Feeding behavior; Foot - innervation; Foot Joints - physiopathology; Fundamental and applied biological sciences. Psychology; Gait Disorders, Neurologic - etiology; Gait Disorders, Neurologic - physiopathology; Humans; Medical sciences; Middle Aged; peripheral neuropathy; Retrospective Studies; Sensation - physiology; Sensation Disorders - etiology; Sensation Disorders - physiopathology; sensory loss; Thermosensing - physiology; Touch - physiology; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Vibration; Endocrinopathy; Human; Obesity; Skin disease; Nervous system diseases; Vibration; Nutrition; Diabetic Foot; Diabetes mellitus; Nutrition disorder; Metabolic diseases; sensory loss; peripheral neuropathy; Sensitivity; Disease of the foot; Charcot; Sensory disorder; Unilateral; Attenuation; Peripheral nerve disease; Endocrinology; Nutritional status
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/j.1464-5491.2012.03598.x

Diabet. Med. 29, 1191‐1194 (2012) Aims  To further characterize the distal sensory neuropathy in subjects with unilateral diabetic Charcot foot neuroarthropathy. Methods  A retrospective cohort study to assess the level to which the sensory modalities of pinprick, light touch, vibration, joint position and temperature were attenuated in the affected and unaffected limbs in subjects with unilateral Charcot. The level to which the sensory modality was attenuated in each limb was assigned a score. The Wilcoxon signed rank test was used to compare the scores in the affected and unaffected limbs and also to compare the scores of the different sensory modalities in the affected and unaffected limbs. Results  Fifty subjects with unilateral Charcot foot neuroarthropathy were assessed. Mean age was 45 ± SD 6 years for the 17 subjects with Type 1 diabetes and 62 ± 10 years for the 33 subjects with Type 2 diabetes. Duration of diabetes was 21 ± 13 years, HbA1c was 70 ± 19 mmol/mol [8.6 ± 1.8 %] and 15 subjects (30%) required renal replacement therapy. The level of attenuation of vibration sensation was more proximal in the affected compared with the unaffected limbs (P = 0.002). Pinprick, light touch, joint position and temperature sensations were not different. Joint position sensation was less attenuated bilaterally than the other sensory modalities. Conclusions  Asymmetrical attenuation of vibration sensation may predict the side that will develop a Charcot joint and may suggest a more important role for vibration sense loss than loss of other sensory modalities in the pathophysiology of Charcot.