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Asymmetrical attenuation of vibration sensation in unilateral diabetic Charcot foot neuroarthropathy
Author(s) -
Valabhji J.,
Marshall R. C.,
Lyons S.,
Bloomfield L.,
Hogg D.,
Rosenfeld P.,
Gabriel C. M.
Publication year - 2012
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2012.03598.x
Subject(s) - medicine , sensation , foot (prosody) , diabetes mellitus , diabetic foot , pain sensation , physical medicine and rehabilitation , attenuation , surgery , anesthesia , endocrinology , neuroscience , physics , optics , philosophy , linguistics , biology
Diabet. Med. 29, 1191‐1194 (2012) Abstract 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, HbA 1c 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.