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Journal ArticleDOI

Touch pressure and sensory density after tarsal tunnel release in diabetic neuropathy

TL;DR: There was marked, significant postoperative improvement of mean touch pressure 1-point threshold, compared with preoperative values, for medial calcaneal, medial plantar, and lateral plantar nerves in both non-diabetic and diabetic patients.
About: This article is published in Foot and Ankle Surgery.The article was published on 2012-12-01. It has received 13 citations till now. The article focuses on the topics: Tarsal tunnel & Diabetic neuropathy.
Citations
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01 Jan 1996
TL;DR: In this paper, the authors used NHDS data for seven foot ulcer related conditions from 1983 to 1990 to illustrate trends in inpatient hospitalization, showing an overall increase of approximately 50% in the age standardized proportion of hospital discharges listing diabetes and lower extremity ulcers during this interval.
Abstract: Diabetic foot ulcers are common and estimated to affect 15% of all diabetic individuals during their lifetimes. The majority of foot ulcers are treated in outpatient settings where surveillance is limited. Hospital discharge data from select countries indicated that 6-20 % of all diabetic individuals hospitalized had a lower extremity ulcer condition.2•3 To illustrate trends in inpatient hospitalization, US National Hospital Discharge Survey Data (NHDS) data for seven foot ulcer related conditions from 1983 to 1990 will be used. These data revealed an overall increase of approximately 50% in the age standardized proportion of hospital discharges listing diabetes and lower extremity ulcers during this interval.2 The highest rates were observed in patients ages 45-64 years while the lowest rates documented were in patients ages 044 years. The age-standardized proportion of hospital discharges listing diabetes and lower extremity ulcers showed that diabetic foot ulcer rates were consistently

267 citations

Journal ArticleDOI
TL;DR: Although corticosteroid injections have a role in the management of select diagnoses, they should be used with caution.
Abstract: Heel pain is commonly encountered in orthopaedic practice. Establishing an accurate diagnosis is critical, but it can be challenging due to the complex regional anatomy. Subacute and chronic plantar and medial heel pain are most frequently the result of repetitive microtrauma or compression of neurologic structures, such as plantar fasciitis, heel pad atrophy, Baxter nerve entrapment, calcaneal stress fracture, and tarsal tunnel syndrome. Most causes of inferior heel pain can be successfully managed nonsurgically. Surgical intervention is reserved for patients who do not respond to nonsurgical measures. Although corticosteroid injections have a role in the management of select diagnoses, they should be used with caution.

96 citations

Journal ArticleDOI
TL;DR: Surgical decompression of the nerves of the lower extremity can be added as a therapeutic option for patients with painful diabetic neuropathy who show signs of chronic nerve compression by means of a positive Tinel or other diagnostic criteria, when pain medication fails to reduce pain to an acceptable standard.
Abstract: BACKGROUND The authors aimed to assess the effect of lower extremity nerve decompression surgery for painful diabetic polyneuropathy on pain and sensibility. METHODS The study was conducted as a single-center randomized controlled trial of one intervention with 1-year follow-up. Forty-two patients with painful diabetic neuropathy were included. After randomization, the lower extremity nerves were decompressed at four sites in one limb. The contralateral limb was used as control (within-patient comparison). All patients were assessed preoperatively and at 3, 6, and 12 months postoperatively. Primary outcome was the visual analogue scale score 12 months after surgery. Secondary outcomes were Semmes Weinstein monofilament testing and two-point discrimination outcomes at 3, 6, and 12 months. RESULTS Visual analogue scale scores improved significantly from a mean of 6.1 (95 percent CI, 5.5 to 6.7) preoperatively to 3.5 (95 percent CI, 2.5 to 4.4) at 12 months postoperatively (p<0.001). The score was also significantly lower compared with the control leg score of 5.3 (95 percent CI, 4.4 to 6.2; p<0.001) at 12 months. Overall, 73.7 percent of the patients improved their score on the visual analogue scale, of which 35.7 percent had a decrease of more than five points. CONCLUSION Surgical decompression of the nerves of the lower extremity can be added as a therapeutic option for patients with painful diabetic neuropathy who show signs of chronic nerve compression by means of a positive Tinel or other diagnostic criteria, when pain medication fails to reduce pain to an acceptable standard. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, I.

39 citations

Journal ArticleDOI
TL;DR: The authors’ results suggest that the beneficial effects of lower extremity nerve decompression surgery are reserved for a select group of patients, of which preoperative nerve damage, age, duration of diabetes, and body mass index are important effect modifiers.
Abstract: Background There is still debate regarding whether the surgical release of entrapped lower extremity nerves reduces complaints of associated neuropathy and results in gain of sensory function. The aim of this study was to investigate which factors are associated with a favorable surgical outcome, by follow-up of patients previously participating in a randomized controlled trial. Methods The authors evaluated the 5-year follow-up of diabetic patients previously participating in the Lower Extremity Nerve Entrapment Study (LENS). Visual analogue pain scores, satisfaction, complaints, quality of life (i.e., 36-Question Short-Form Health Survey and EuroQol 5 Dimensions instrument), sensory function, and incident ulceration and amputation were assessed. Differences between patients who underwent unilateral versus bilateral decompressions were investigated. Results Thirty-one of the original 42 LENS participants were measured, of which eight patients underwent additional decompression of the contralateral leg, after 12-month LENS follow-up. At 5 years, bilateral surgical patients (n = 8) had significantly lower pain scores and higher quality of life compared with unilateral surgical patients (n = 23), were younger, had a lower age when diagnosed with diabetes, and had a lower body mass index at baseline. Pain scores of the additional decompressed leg decreased in a manner similar to that of the initial decompressed leg during follow-up. Patients with severe preoperative sensory loss did worse; 41.2 percent of the LENS Follow-Up Study subjects underwent or considered undergoing contralateral surgery. Conclusion The authors' results suggest that the beneficial effects of lower extremity nerve decompression surgery are reserved for a select group of patients, of which preoperative nerve damage, age, duration of diabetes, and body mass index are important effect modifiers. Clinical question/level of evidence Therapeutic, III.

12 citations

Journal ArticleDOI
TL;DR: This secondary compression thesis and operative treatment methodology may deserve reassessment in view of the potential for nerve decompression to be useful in addressing some of the more difficult, expensive, and life altering complications of diabetic neuropathy.
Abstract: External neurolysis of the nerve at fibro-osseous tunnels has been proprosed to treat or prevent signs, symptoms, and complications in the lower extremity of diabetes patients with sensorimotor polyneuropathy. Nerve decompression is justified in the presence of symptomatic compressed nerves in the several fibro-osseous tunnels of the extremities, which are known to be frequent in diabetes. Quite a body of literature has accumulated reporting results after such nerve decompression in the leg, describing pain relief and sensibility improvement, as well as balance recovery, diabetic foot ulcer prevention, curtailed ulcer recurrence risk, and amputation avoidance.Historical academic hesitance to endorse surgical treatments for pain and numbness in diabetes was based primarily on the early retrospective reports’ potential for bias and placebo effects, and that the hypothetical basis for surgery lies outside the traditional etiology paradigm of length-dependent axonopathy. This reticence is here critiqu...

10 citations

References
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Book
01 Jan 1974
TL;DR: Applied Linear Statistical Models 5e as discussed by the authors is the leading authoritative text and reference on statistical modeling, which includes brief introductory and review material, and then proceeds through regression and modeling for the first half, and through ANOVA and Experimental Design in the second half.
Abstract: Applied Linear Statistical Models 5e is the long established leading authoritative text and reference on statistical modeling. The text includes brief introductory and review material, and then proceeds through regression and modeling for the first half, and through ANOVA and Experimental Design in the second half. All topics are presented in a precise and clear style supported with solved examples, numbered formulae, graphic illustrations, and "Notes" to provide depth and statistical accuracy and precision. The Fifth edition provides an increased use of computing and graphical analysis throughout, without sacrificing concepts or rigor. In general, the 5e uses larger data sets in examples and exercises, and where methods can be automated within software without loss of understanding, it is so done.

10,747 citations

Book
01 Jan 1972
TL;DR: In this paper, the authors present a survey of statistical and data analysis methods for probability distributions and their application to statistical quality control problems, including one and two Sided Tests of Hypotheses.
Abstract: 1. Introduction to Statistics and Data Analysis 2. Probability 3. Random Variables and Probability Distributions 4. Mathematical Expectations 5. Some Discrete Probability Distributions 6. Some Continuous Probability Distributions 7. Functions of Random Variables (optional) 8. Fundamental Distributions and Data Description 9. One and Two Sample Estimation Problems 10. One and Two Sided Tests of Hypotheses 11. Simple Linear Regression 12. Multiple Linear Regression 13. One Factor Experiments: General 14. Factorial Experiments (Two or More Factors) 15. 2k Factorial Experiments and Fractions 16. Nonparametric Statistics 17. Statistical Quality Control 18. Bayesian Statistics

2,945 citations

Journal ArticleDOI
TL;DR: Defining causal pathways that predispose to diabetic limb amputation suggests practical interventions that may be effective in preventing diabetic limb loss.
Abstract: We defined the causal pathways responsible for 80 consecutive initial lower-extremity amputations to an extremity in diabetic patients at the Seattle Veterans Affairs Medical Center over a 30-mo interval from 1984 to 1987. Causal pathways, either unitary or composed of various combinations of seven potential causes (i.e., ischemia, infection, neuropathy, faulty wound healing, minor trauma, cutaneous ulceration, gangrene), were determined empirically after a synthesis by the investigators of various objective and subjective data. Estimates of the proportion of amputations that could be ascribed to each component cause were calculated. Twenty-three unique causal pathways to diabetic limb amputation were identified. Eight frequent constellations of component causes resulted in 73% of the amputations. Most pathways were composed of multiple causes, with only critical ischemia from acute arterial occlusions responsible for amputations as a singular cause. The causal sequence of minor trauma, cutaneous ulceration, and wound-healing failure applied to 72% of the amputations, often with the additional association of infection and gangrene. We specified precise criteria in the definition of causal pathway to permit estimation of the cumulative proportion of amputations due to various causes. Forty-six percent of the amputations were attributed to ischemia, 59% to infection, 61% to neuropathy, 81% to faulty wound healing, 84% to ulceration, 55% to gangrene, and 81% to initial minor trauma. An identifiable and potentially preventable pivotal event, in most cases an episode involving minor trauma that caused cutaneous injury, preceded 69 to 80 amputations. Defining causal pathways that predispose to diabetic limb amputation suggests practical interventions that may be effective in preventing diabetic limb loss.

1,465 citations


"Touch pressure and sensory density ..." refers background in this paper

  • ...Nonhealing neuropathic ulcers precede amputation in 84% of lower extremity amputations in diabetic patients [6], and 11–41% of diabetic patients die within 1 year of a lower extremity amputation [1]....

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Journal ArticleDOI
TL;DR: This review will discuss the clinical features, assessment, and management of the patient with the most common form of DN, diabetic distal sensory polyneuropathy (DPN), and the late sequelae of DPN and their prevention.
Abstract: ropathic pain (7–10), and this and other putative mechanisms will be discussed The clinical features, diagnosis, and management of the focal and multifocal neuropathies will be described A major portion of this review will discuss the clinical features, assessment, and management of the patient with the most common form of DN, diabetic distal sensory polyneuropathy (DPN) The late sequelae of DPN and their prevention will also be described Finally, practical guidelines for the screening of DPN in clinical practice will be provided For further details on this topic, please refer to recent reviews (11– 18)

848 citations


"Touch pressure and sensory density ..." refers background or methods in this paper

  • ...the assessment of sensory threshold for protective sensation using Semmes–Weinstein monofilaments (evaluating 1-point touch pressure sensory threshold of large fiber myelinated nerve endings) and does not include 2-point discrimination testing for sensory density of small fiber unmyelinated nerve endings [4]....

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  • ...001 compressive neuropathy, such as entrapment or compression of the posterior tibial nerve at the tarsal tunnel, resulting in secondary neuronal edema, inflammatory injury, and symptoms of diabetic neuropathy [4,9,10]....

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  • ...diabetic patients who have a plantar sensory deficit [4]....

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  • ...Neuropathic symptoms affect 30–40% of patients with diabetes [4,5]....

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