title: Accelerated atrophy of lower leg and foot muscles--a follow-up study of long-term diabetic polyneuropathy using magnetic resonance imaging (MRI).
abstract: OBJECTIVE
  The aim of the study was to determine the loss of muscle volume in the lower leg and foot in long-term diabetic patients in relation to the presence of neuropathy.
  
  
  METHODS
  We re-examined 26 type 1 diabetic patients who had participated in magnetic resonance imaging (MRI) studies on muscle volume in the lower leg and foot 9 to 12 years earlier. Re-examination involved MRI, isokinetic dynamometry, clinical examination, electrophysiological studies and quantitative sensory examinations.
  
  
  RESULTS
  Annual loss of muscle volume of ankle dorsal and plantar flexors was 4.5 (5.5-3.9)% (median [range]) and 5.0 (7.0-4.2)% in neuropathic patients, 1.9 (3.2-1.0)% and 1.8 (2.6-1.3)% in non-neuropathic patients, and 1.7 (2.8-0.8)% and 1.8 (2.4-0.8)% in controls, respectively (p < 0.01). Annual change of volume and strength correlated for ankle dorsal flexors (r (s) = 0.73, p < 0.01) and for ankle plantar flexors (r (s) = 0.63, p < 0.05) in diabetic patients. In addition, annual change of muscle volume for dorsal and plantar flexors was related to the combined score of all measures of neuropathy (r (s) = -0.68, p < 0.02 and r (s) = -0.73, p < 0.01, respectively). Foot muscle volume declined annually by 3.0 (3.4-1.0)% in neuropathic patients and by 1.1 (4.0-0.2)% in non-neuropathic patients, both values being significantly different from controls (0.2 [-2.5 to 2.4]%). Loss of foot muscle volume was related to severity of neuropathy assessed at clinical evaluation (r (s) = -0.6, p < 0.05).
  
  
  CONCLUSIONS
  Muscular atrophy in long-term diabetic neuropathy occurs early in the feet, progresses steadily in the lower legs, relates to severity of neuropathy and leads to weakness at the ankle.
authors.affiliation: Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark. christer.andreassen@ki.au.dk
authors.forename: C S
authors.initials: CS
authors.lastname: Andreassen
authors.forename: J
authors.initials: J
authors.lastname: Jakobsen
authors.forename: S
authors.initials: S
authors.lastname: Ringgaard
authors.forename: N
authors.initials: N
authors.lastname: Ejskjaer
authors.forename: H
authors.initials: H
authors.lastname: Andersen
mesh_terms: D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000473:pathology*; D006801:Humans; D007866:Leg / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D009133:Muscular Atrophy / Q000473:pathology*