title: Evaluation of Peripheral Neuropathy of Unknown Origin in an Outpatient Foot and Ankle Practice.
abstract: BACKGROUND
  The foot and ankle surgeon can see peripheral neuropathy in the treatment of foot and ankle conditions. The purpose of this study was (1) to evaluate the demographics and presenting complaints of patients diagnosed with idiopathic peripheral neuropathy during an examination by a foot and ankle surgeon and (2) to identify the type and frequency of subsequent diagnosis of medical causes of neuropathy.
  
  
  METHODS
  This was a retrospective study of patients diagnosed with idiopathic peripheral neuropathy in our practice between January 1997 and December 2008. Ninety-five patients were identified, and demographic data, presenting complaints, and medical comorbidities were extracted from the medical record. Examination findings of decreased sensation to Semmes Weinstein 5.07 monofilament testing were documented, and electromyogram and nerve conduction study results were reviewed when available. Laboratory values were noted, as were neurologic evaluations performed to diagnose medical conditions associated with peripheral neuropathy.
  
  
  RESULTS
  The most common presentation was foot pain, in 36 patients (38%). Ninety-one patients had Semmes Weinstein 5.07 monofilament testing, with loss of protective sensation reported in 75 of the 91 tested (82%). Only 30 of the 95 patients had electromyogram and nerve conduction study results available, with a test positive for peripheral neuropathy in 20 of the 30 tested. Thirty-two patients were evaluated by a neurologist. A specific cause was identified in 12 of the 32 seen by a neurologist. Of the total group of 95 patients, 31 patients (33%) were diagnosed with a condition that may be associated with peripheral neuropathy.
  
  
  CONCLUSIONS
  Thirty-three percent of the patients presenting to our clinic and given a diagnosis of idiopathic peripheral neuropathy were ultimately diagnosed with a medical cause of neuropathy-most commonly, diabetes. For those patients with idiopathic neuropathy, a spectrum of disease was encountered, including pain, ulcer, infection, and Charcot neuroarthropathy.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA kleins@wustl.edu.
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Klein
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chu
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: McCormick
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001177:Arthropathy, Neurogenic / Q000209:etiology; D003920:Diabetes Mellitus / Q000175:diagnosis; D005260:Female; D016523:Foot Ulcer / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology; D010808:Physical Examination; D012189:Retrospective Studies; D018461:Soft Tissue Infections; D055815:Young Adult
keywords: Charcot arthropathy; diabetes mellitus; foot pain; peripheral neuropathy