Symptomatic Reversal of Peripheral Neuropathy in Patients with Diabetes

2002 ◽  
Vol 92 (3) ◽  
pp. 125-130 ◽  
Author(s):  
Alan B. Kochman ◽  
Dale H. Carnegie ◽  
Thomas J. Burke
Keyword(s):  
Peripheral Neuropathy ◽  
Near Infrared ◽  
Diabetic Patients ◽  
Cold Sensation ◽  
Noninvasive Treatment ◽  
Patients With Diabetes ◽  
Protective Sensation ◽  
Loss Of Protective Sensation ◽  
Drug Free ◽  
Sensation Loss

Forty-nine consecutive subjects with established diabetic peripheral neuropathy were treated with monochromatic near-infrared photo energy (MIRE) to determine if there was an improvement of sensation. Loss of protective sensation characterized by Semmes-Weinstein monofilament values of 4.56 and above was present in 100% of subjects (range, 4.56 to 6.45), and 42 subjects (86%) had Semmes-Weinstein values of 5.07 or higher. The ability to discriminate between hot and cold sensation was absent (54%) or impaired (46%) in both groups prior to the initiation of MIRE treatment. On the basis of Semmes-Weinstein monofilament values, 48 subjects (98%) exhibited improved sensation after 6 treatments, and all subjects had improved sensation after 12 treatments. Therefore, MIRE may be a safe, drug-free, noninvasive treatment for the consistent and predictable improvement of sensation in diabetic patients with peripheral neuropathy of the feet. (J Am Podiatr Med Assoc 92(3): 125-130, 2002)

Biomechanical Properties of the Foot Sole in Diabetic Mellitus Patients

2014 ◽  
Vol 3 (1) ◽  
pp. 1-17 ◽  
Author(s):  
V. B. Narayanamurthy ◽  
Richa Poddar ◽  
R. Periyasamy
Keyword(s):  
Pressure Distribution ◽  
Biomechanical Properties ◽  
Distribution Parameter ◽  
Diabetic Patients ◽  
Ulcer Formation ◽  
Wear Properties ◽  
History Of ◽  
Protective Sensation ◽  
Index Value ◽  
Loss Of Protective Sensation

This aricle evaluates and quantifies the biomechanical properties of the foot sole like – loss of protective sensation, hardness of the foot sole and pressure distribution parameter called Power ratio (PR) and its alterations, which have a direct effect on ulcer formation. A new parameter PRS Index is developed to understand the interplay between these parameters and its role in ulcer formation. All diabetic subjects attending the Diabetic foot clinic from Dec2003 to June 2007 undergo a standard foot examination.A total of 652 diabetic patients including 57 ulcer patients are taken for our study. The biomechanical properties include loss of protective sensation (LOPS) which is measured by 10 gm Semmes Weinstein Monofilament (SWMF). Hardness of the foot sole or absence of suppleness is tested using the Durometer (ASTM-D 2240 standards). Plantar pressure measurement is done using the PedoPowerGraph(p) which measures pressure distribution parameter PR. Foot wear properties like hardness of the insole affecting the formation of plantar ulcers was also measured. The above mentioned important parameters can be measured objectively and calculate PRS index value for diabetic with history of previous ulcer patients. We found a single entity of either the PR or shore independently cannot predict the risk for ulcer formation.In this study we found newPRS index value for diabetic with history of previous ulcer patients show significant correlation (i.e. p<0.05 level) between footwear shore and PRS index for history of previous ulcer patients. No significant correlation was shown for diabetic without history of previous ulcer patients and this may be due to diabetic patients are wearing footwear randomly with different degree Shore. From the case studies we found that the PRS index values and other biomechanical parameter of the foot sole can be reversed if the patients wear proper MCR footwear with 20 degree Shore. Use of appropriate footwear has shown that these easily measurable parameters and thus prevent ulcer formation as mentioned in the earlier studies. Several methods are used previously for predicting ulceration in DM patients. But in this study the new index PRS was studied and its role in predicting ulceration. Use of appropriate footwear will reverse the hypertrophic response; this can be quantified by the PRS index. We have found that there is decrease in PRS index by proper off loading the pressure using 20-degree shore MCR footwear.

Improved Sensitivity in Patients with Peripheral Neuropathy

2005 ◽  
Vol 95 (2) ◽  
pp. 143-147 ◽  
Author(s):  
Salvatore L. DeLellis ◽  
Dale H. Carnegie ◽  
Thomas J. Burke
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Peripheral Neuropathy ◽  
Diabetic Foot ◽  
Medical Records ◽  
Significant Clinical Improvement ◽  
The Mean ◽  
Protective Sensation ◽  
Loss Of Protective Sensation ◽  
Foot Sensation

The medical records of 1,047 patients (mean age, 73 years) with established peripheral neuropathy were examined to determine whether treatment with monochromatic infrared photo energy was associated with increased foot sensitivity to the 5.07 Semmes-Weinstein monofilament. The peripheral neuropathy in 790 of these patients (75%) was due to diabetes mellitus. Before treatment with monochromatic infrared photo energy, of the ten tested sites (five on each foot), a mean ± SD of 7.9 ± 2.4 sites were insensitive to the 5.07 Semmes-Weinstein monofilament, and 1,033 patients exhibited loss of protective sensation. After treatment, the mean ± SD number of insensate sites on both feet was 2.3 ± 2.4, an improvement of 71%. Only 453 of 1,033 patients (43.9%) continued to have loss of protective sensation after treatment. Therefore, monochromatic infrared photo energy treatment seems to be associated with significant clinical improvement in foot sensation in patients, primarily Medicare aged, with peripheral neuropathy. Because insensitivity to the 5.07 Semmes-Weinstein monofilament has been reported to be a major risk factor for diabetic foot wounds, the use of monochromatic infrared photo energy may be associated with a reduced incidence of diabetic foot wounds and amputations. (J Am Podiatr Med Assoc 95(2): 143–147, 2005)

scholarly journals Is the metabolic cost of walking higher in people with diabetes?

2016 ◽  
Vol 120 (1) ◽  
pp. 55-62 ◽  
Author(s):  
M. Petrovic ◽  
K. Deschamps ◽  
S. M. Verschueren ◽  
F. L. Bowling ◽  
C. N. Maganaris ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Lower Limb ◽  
Metabolic Cost ◽  
Diabetic Patients ◽  
Motion Analysis System ◽  
Gas Analyzer ◽  
Joint Work ◽  
Patients With Diabetes ◽  
Analysis System ◽  
Walking Speeds

People with diabetes walk slower and display biomechanical gait alterations compared with controls, but it remains unknown whether the metabolic cost of walking (CoW) is elevated. The aim of this study was to investigate the CoW and the lower limb concentric joint work as a major determinant of the CoW, in patients with diabetes and diabetic peripheral neuropathy (DPN). Thirty-one nondiabetic controls (Ctrl), 22 diabetic patients without peripheral neuropathy (DM), and 14 patients with moderate/severe DPN underwent gait analysis using a motion analysis system and force plates and treadmill walking using a gas analyzer to measure oxygen uptake. The CoW was significantly higher particularly in the DPN group compared with controls and also in the DM group (at selected speeds only) compared with controls, across a range of matched walking speeds. Despite the higher CoW in patients with diabetes, concentric lower limb joint work was significantly lower in DM and DPN groups compared with controls. The higher CoW is likely due to energetic inefficiencies associated with diabetes and DPN reflecting physiological and biomechanical characteristics. The lower concentric joint work in patients with diabetes might be a consequence of kinematic gait alterations and may represent a natural strategy aimed at minimizing the CoW.

Prevalence, Clinical Presentation, and Factors Associated With Diabetic Foot Ulcer in Two Regional Hospitals in Cameroon

2018 ◽  
Vol 17 (1) ◽  
pp. 42-47 ◽  
Author(s):  
Maxime Tindong ◽  
John N. Palle ◽  
Daniel Nebongo ◽  
Leopold Ndemnge Aminde ◽  
Yannick Mboue-Djieka ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Clinical Presentation ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Disease ◽  
Patients With Diabetes ◽  
Protective Sensation ◽  
Peripheral Arterial ◽  
Loss Of Protective Sensation ◽  
Regional Hospitals

This study aimed to determine the prevalence of diabetic foot ulcer and high risk for ulceration, describe the clinical presentation, and identify factors associated with diabetic foot ulcer in the Southwest regional hospitals of Cameroon. In this cross-sectional study, data were collected using a structured questionnaire administered to consecutive patients with diabetes. Findings from detailed foot examination were recorded. Diabetic foot ulcer was diagnosed according to the International Working Group on Diabetic Foot (IWGDF) definition. Data were analyzed with Stata IC version 12. Of the 203 participants included, 63.1% were females. Age ranged from 26 to 96 years. The median duration of diabetes was 4.0 years (interquartile range 1.0-8.0 years). The prevalence of diabetic foot ulcer was 11.8% (24), of whom 29.2% (7) had high grade (grades 2 to 4), and most of the ulcers 58.3% (14) were located at the plantar region. The prevalence of high risk for ulceration was 21.8% (39). Loss of protective sensation (OR = 3.73, 95% CI = 1.43-9.71; P = .007), and peripheral arterial disease (OR = 3.48, 95% CI = 1.14-10.56; P = .028) were independently associated with diabetic foot. Diabetic foot ulcer is a common complication among patients with diabetes attending these regional hospitals. Loss of protective sensation, and peripheral arterial disease increase the odds of having diabetic foot ulcer, and we suggest them as the main target of interest for prevention.

Biomechanical Properties of the Foot Sole in Diabetic Mellitus Patients

2018 ◽  
pp. 444-460
Author(s):  
V. B. Narayanamurthy ◽  
Richa Poddar ◽  
R. Periyasamy
Keyword(s):  
Pressure Distribution ◽  
Biomechanical Properties ◽  
Distribution Parameter ◽  
Diabetic Patients ◽  
Ulcer Formation ◽  
Hypertrophic Response ◽  
History Of ◽  
Protective Sensation ◽  
Index Value ◽  
Loss Of Protective Sensation

This aricle evaluates and quantifies the biomechanical properties of the foot sole like – loss of protective sensation, hardness of the foot sole and pressure distribution parameter called Power ratio (PR) and its alterations, which have a direct effect on ulcer formation. A new parameter PRS Index is developed to understand the interplay between these parameters and its role in ulcer formation. All diabetic subjects attending the Diabetic foot clinic from Dec2003 to June 2007 undergo a standard foot examination. A total of 652 diabetic patients including 57 ulcer patients are taken for our study. The biomechanical properties include loss of protective sensation (LOPS) which is measured by 10 gm Semmes Weinstein Monofilament (SWMF). Hardness of the foot sole or absence of suppleness is tested using the Durometer (ASTM-D 2240 standards). Plantar pressure measurement is done using the PedoPowerGraph(p) which measures pressure distribution parameter PR. Foot wear properties like hardness of the insole affecting the formation of plantar ulcers was also measured. The above mentioned important parameters can be measured objectively and calculate PRS index value for diabetic with history of previous ulcer patients. We found a single entity of either the PR or shore independently cannot predict the risk for ulcer formation. In this study we found new PRS index value for diabetic with history of previous ulcer patients show significant correlation (i.e. p<0.05 level) between footwear shore and PRS index for history of previous ulcer patients. No significant correlation was shown for diabetic without history of previous ulcer patients and this may be due to diabetic patients are wearing footwear randomly with different degree Shore. From the case studies we found that the PRS index values and other biomechanical parameter of the foot sole can be reversed if the patients wear proper MCR footwear with 20 degree Shore. Use of appropriate footwear has shown that these easily measurable parameters and thus prevent ulcer formation as mentioned in the earlier studies. Several methods are used previously for predicting ulceration in DM patients. But in this study the new index PRS was studied and its role in predicting ulceration. Use of appropriate footwear will reverse the hypertrophic response; this can be quantified by the PRS index. We have found that there is decrease in PRS index by proper off loading the pressure using 20-degree shore MCR footwear.

scholarly journals Comparison of Efficiencies of Michigan Neuropathy Screening Instrument, Neurothesiometer, and Electromyography for Diagnosis of Diabetic Neuropathy

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Turkan Mete ◽  
Yusuf Aydin ◽  
Mustafa Saka ◽  
Halise Cinar Yavuz ◽  
Sule Bilen ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Physical Examination ◽  
Diabetic Peripheral Neuropathy ◽  
Diabetes Type 2 ◽  
Screening Instrument ◽  
Diabetes Type ◽  
Diabetic Patients ◽  
Patients With Diabetes ◽  
Michigan Neuropathy Screening Instrument

Aim. This study compares the effectiveness of Michigan Neuropathy Screening Instrument (MNSI), neurothesiometer, and electromyography (EMG) in detecting diabetic peripheral neuropathy in patients with diabetes type 2.Materials and Methods. 106 patients with diabetes type 2 treated at the outpatient clinic of Ankara Numune Education and Research Hospital Department of Endocrinology between September 2008 and May 2009 were included in this study. Patients were evaluated by glycemic regulation tests, MNSI (questionnaire and physical examination), EMG (for detecting sensorial and motor defects in right median, ulnar, posterior tibial, and bilateral sural nerves), and neurothesiometer (for detecting alterations in cold and warm sensations as well as vibratory sensations).Results. According to the MNSI score, there was diabetic peripheral neuropathy in 34 (32.1%) patients (score ≥2.5). However, when the patients were evaluated by EMG and neurothesiometer, neurological impairments were detected in 49 (46.2%) and 79 (74.5%) patients, respectively.Conclusion. According to our findings, questionnaires and physical examination often present lower diabetic peripheral neuropathy prevalence. Hence, we recommend that in the evaluation of diabetic patients neurological tests should be used for more accurate results and thus early treatment options to prevent neuropathic complications.

scholarly journals Determination of Oxygen Tension in Peripheral Neuropathy and Diabetes using Nirs Method

2019 ◽  
Vol 8 (4) ◽  
pp. 11333-11335
Keyword(s):  
Wound Healing ◽  
Infrared Spectroscopy ◽  
Peripheral Neuropathy ◽  
Oxygen Tension ◽  
Near Infrared ◽  
Visual Display ◽  
Peripheral Vascular ◽  
Amputation Level ◽  
Patients With Diabetes

According to WHO, India had 69.2 million people living with diabetes in 2015 and is expected to rise by more than a 5th from 406 million in 2018 to 511 million in 2030. Diabetes currently affects over 425 million people worldwide. Chronic Blood sugar and diabetes may cause severe nerve damage known as Peripheral neuropathy. Approximately 15% of patients with diabetes are affected with diabetes. Various studies have indicated that peripheral vascular disease is related to tissue hypoxia and clinical device monitors uses pulse oximetry principle to measure changes of light absorption in oxygenated and deoxygenated blood. In this project we intend to develop a portable device to assess oxygen tension near foot ulcerate area using NIRS (Near infrared spectroscopy) method in diabetic subjects. The results can be visualized in the LCD and Visual display. The main purpose of oxygen tension estimation is to have a better understanding in wound healing potential, assessment of success in revascularization, and predictability of amputation level and the study the need of hyperbaric oxygen in therapy.

scholarly journals Comparative study of diabetes foot diagnosis using ABPI

2018 ◽  
Vol 7 (2.25) ◽  
pp. 40
Author(s):  
G Hari Krishnan ◽  
G S Arun Kumar ◽  
V Arun ◽  
R Saravana
Keyword(s):  
Peripheral Neuropathy ◽  
Low Cost ◽  
Ankle Brachial Pressure Index ◽  
End User ◽  
Digital Output ◽  
Pressure Index ◽  
Protective Sensation ◽  
Loss Of Protective Sensation ◽  
User Friendly ◽  
User Condition

User friendly product has been developed to analyze the user condition accurately and provide a digital output with low cost product to the end user for diagnosing diabetes foot. Detecting the level of peripheral neuropathy which significantly increases the risk of sustaining a foot wound called ‘loss of protective sensation. To implement a device to detect foot diabetes in patients using the Ankle Brachial pressure index values. The proposed system was tested by conducting experiment on 9 patients and whose ABPI value measured confirms the convention-al measured values.  

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