BACKGROUND Patients with diabetic peripheral neuropathy (DPN) suffer from numbness, burning feet, lightning pain, and pins-and-needles sensations. Recently, High resolution ultrasonography is commonly used for evaluation of peripheral nerve diseases because of its easy availability, time saving and non-invasiveness of the procedure. This study intended to compare the cross sectional area (CSA) of posterior tibial nerve (PTN) in type 2 diabetic patients with peripheral neuropathy with that of non-diabetic healthy adults using high resolution ultrasonography (HRU) and study the role of increase in HbA1c level and severity of DPN comparing with CSA of PTN. METHODS A cross sectional comparative descriptive study was conducted from November 2018 to May 2020 with 50 type 2 diabetic patients and 50 healthy adults. 50 type 2 diabetic patients, clinically diagnosed with DPN were analysed and using the Toronto Clinical Neuropathy Score (TCNS) System, the severity of neuropathy was determined. HbA1c level and other demographic data were collected. 50 healthy adults were taken as controls. The CSA of posterior tibial nerve was measured 3 cm proximal to the medial malleolus in both lower limbs using HRU. RESULTS The mean CSA of posterior tibial nerve in healthy subjects was 6.0 + / - 0.142 mm2 , and in diabetic patients with peripheral neuropathy was 11.77 + / - 0.291 mm2 . Upon comparing the mean CSA of posterior tibial nerve of diabetic subjects with peripheral neuropathy and control subjects were statistically significant (P < 0.001) in unpaired ‘t’ test. In our study, CSA of the posterior tibial nerve correlated significantly with TCNS and HbA1c levels, at P < 0.001. CONCLUSIONS This study showed that there is a significant difference between the cross sectional areas of posterior tibial nerve in diabetic subjects with peripheral neuropathy and healthy adult subjects. HRU can detect cross sectional area changes in the posterior tibial nerve early. Thus, ultrasonography can be used as a good screening tool in these patients. KEYWORDS Diabetic Peripheral Neuropathy, Posterior Tibial Nerve, High Resolution Ultrasonography
High-resolution ultrasonography of the sural nerve in diabetic peripheral neuropathy