title: Asymmetrical attenuation of vibration sensation in unilateral diabetic Charcot foot neuroarthropathy.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK. jonathan.valabhji@imperial.nhs.uk
authors.forename: J
authors.initials: J
authors.lastname: Valabhji
authors.forename: R C
authors.initials: RC
authors.lastname: Marshall
authors.forename: S
authors.initials: S
authors.lastname: Lyons
authors.forename: L
authors.initials: L
authors.lastname: Bloomfield
authors.forename: D
authors.initials: D
authors.lastname: Hogg
authors.forename: P
authors.initials: P
authors.lastname: Rosenfeld
authors.forename: C M
authors.initials: CM
authors.lastname: Gabriel
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D017719:Diabetic Foot / Q000209:etiology / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000209:etiology / Q000503:physiopathology*; D005528:Foot / Q000294:innervation; D033023:Foot Joints / Q000503:physiopathology; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012677:Sensation / Q000502:physiology*; D012678:Sensation Disorders / Q000209:etiology / Q000503:physiopathology; D013697:Thermosensing / Q000502:physiology; D014110:Touch / Q000502:physiology; D014732:Vibration