Characteristics of lower extremity pressure sensation impairment in developing diabetic sensory polyneuropathy.
The medical literature presents diabetic sensory polyneuropathy as a length-dependent process producing a stocking distribution of sensory loss in the lower extremities. If a purely length-dependent etiology for diabetic sensory polyneuropathy were true, then a validated comparison of sensory loss at any equidistant site about the forefoot will reveal findings consistent with the accepted stocking pattern of anesthesia. A single-blinded, age-matched, control/experimental study is made into the frequency of apparent purely length-dependent A-beta fiber pathology in developing diabetic sensory polyneuropathy. Control (n = 46) and experimental (n = 83) central US subjects are examined with a subjective neuropathy screening questionnaire, vibratory threshold, and single-point pressure threshold testing. There is a plantar predominant pattern (61.5%) of sensory loss in developing diabetic sensory polyneuropathy, even after adjusting for sensitivity differences between different areas of the foot. A typical stocking pattern of sensory loss was not found. Although axonal pathology is length dependent, it is not apparently a purely length-dependent process. Therefore, a purely metabolic explanation for sensory loss is unlikely. In addition, an anatomic component for A-beta fiber pathology is implied by this study.
Rader
Andrew J
AJ
Memorial Hospital and Healthcare Center, The Wound Care Center, Jasper, Indiana 47546, USA. pvppc@fullnet.com
Barry
Timothy P
TP
Stanley
Otis L
OL
D003928:Diabetic Nephropathies / Q000150:complications* / Q000503:physiopathology; D003937:Diagnosis, Differential; D003943:Diagnostic Techniques, Neurological; D018450:Disease Progression; D006801:Humans; D006987:Hypesthesia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D007866:Leg / Q000294:innervation*; D011312:Pressure; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires