Download PDF
Exp Clin Endocrinol Diabetes 2013; 121(04): 239-243
DOI: 10.1055/s-0032-1329981
Short Communication
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Relationship of Limited Joint Mobility and Foot Deformities with Neurological Examination in Patients with Diabetes

I. Sanz-Corbalán
1   Diabetic Foot Unit, Complutense University Clinic, Madrid, Spain
,
J. L. Lázaro-Martínez
1   Diabetic Foot Unit, Complutense University Clinic, Madrid, Spain
,
E. García-Morales
1   Diabetic Foot Unit, Complutense University Clinic, Madrid, Spain
,
J. Aragón-Sánchez
2   Diabetic Foot Unit, La Paloma Hospital, Las Palmas de Gran Canaria, Spain
,
D. Carabantes-Alarcón
1   Diabetic Foot Unit, Complutense University Clinic, Madrid, Spain
,
Y. García-Álvarez
1   Diabetic Foot Unit, Complutense University Clinic, Madrid, Spain
› Author Affiliations
Further Information

Publication History

received14 September 2012
first decision 17 October 2012

accepted 24 October 2012

Publication Date:
17 January 2013 (online)

Also available at
    Permissions and Reprints

Abstract

Aims:

The aim is to define the association of forefoot deformity and limited joint mobility in the ankle and hallux joints in patients with diabetes mellitus subject to different diagnostic tests for diabetic neuropathy.

Prospective study with 118 type 2 diabetic patients (68 men, mean age of 65.6±9.9 years) enrolled consecutively from the Diabetic Foot Unit of the Complutense University of Madrid subject to evaluation of plantar surface sensitivity by 10-g Semmes-Weinstein Monofilament, vibratory threshold by biothesiometer, and sudomotor dysfunction by Neuropad®. The patients presented with limited joint mobility of the ankle and the first metatarsophalangeal joints, and forefoot deformities were registered. Statistical analysis was done through a univariate model to test the association between neurological and biomechanical alteration.

There was an association of abnormal Monofilament (p=0.01; OR=3.9) and biothesiometer tests (p=0.01; OR=2.6) with the presence of forefoot deformity. Furthermore, a relation was found between abnormal Monofilament (p=0.02; OR=4.8) and biothesiometer (p<0.00; OR=12.8) tests with limited mobility of the first metatarsophalangeal joint both in loading and off-loading. Abnormal sudomotor function test was related with limited joint mobility of the ankle joint with the knee flexed (p=0.04; OR=2.8).

Conclusions:

The results of this study show discordance between biomechanical abnormalities and neuropathy depending on the diagnostic test used. Tests that assess large myelinated nerve fibers are associated with the presence of deformities. Abnormal sudomotor function test is associated with limited joint mobility and this test has a greater capacity for selecting patients at risk.

Key words

Diabetic Foot - Diabetic Neuropathy - Biomechanical Alterations - Limited Joint Mobility
 

  • References

  • 1 Boulton AJ, Vinik AI, Arezzo JC et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005; Apr 28: 956-962
    PubMedGoogle Scholar
  • 2 Argiana V, Eleftheriadou I, Tentolouris N. Screening for the high-risk foot of ulceration: tests of somatic and autonomic nerve functionRep. Curr Diab Aug 2011; 11: 294-301
    PubMedGoogle Scholar
  • 3 Andreassen CS, Jakobsen J, Ringgaard S et al. Accelerated atrophy of lower leg and foot muscles – a follow-up study of long-term diabetic polyneuropathy using magnetic resonance imaging (MRI). Diabetologia Jun 2009; 52: 1182-1191
    CrossrefPubMedGoogle Scholar
  • 4 Low VA, Sandroni P, Fealey RD et al. Detection of small-fiber neuropathy by sudomotor testing. Muscle Nerve Jul 2006; 34: 57-61
    CrossrefPubMedGoogle Scholar
  • 5 Papanas N, Ziegler D.. New diagnostic tests for diabetic distal symmetric polyneuropathy. J Diabetes Complications Jan-Feb 2011; 25: 44-51
    CrossrefPubMedGoogle Scholar
  • 6 Boulton AJ. Diabetic neuropathy: classification, measurement and treatment. Curr Opin Endocrinol Diabetes Obes Apr 2007; 14: 141-145
    CrossrefPubMedGoogle Scholar
  • 7 Papanas N, Paschos P, Papazoglou D et al. Accuracy of the Neuropad test for the diagnosis of distal symmetric polyneuropathy in type 2 diabetes. Diabetes Care Jun 2011; 34: 1378-1382
    CrossrefPubMedGoogle Scholar
  • 8 Papanas N, Papatheodorou K, Papazoglou D et al. A prospective study on the use of the indicator test Neuropad(R) for the early diagnosis of peripheral neuropathy in type 2 diabetes. Exp Clin Endocrinol Diabetes Feb 2011; 119: 122-125
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Feng Y, Schlosser FJ, Sumpio BE. The Semmes Weinstein monofilament examination is a significant predictor of the risk of foot ulceration and amputation in patients with diabetes mellitus. J Vasc Surg Jan 2011; 53: 220-226 e1–e5
    CrossrefPubMedGoogle Scholar
  • 10 Oyer DS, Saxon D, Shah A.. Quantitative assessment of diabetic peripheral neuropathy with use of the clanging tuning fork test. Endocr Pract Jan-Feb 2007; 13: 5-10
    CrossrefPubMedGoogle Scholar
  • 11 Pham H, Armstrong DG, Harvey C et al. Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. Diabetes Care May 2000; 23: 606-611
    CrossrefPubMedGoogle Scholar
  • 12 Preventive foot care in people with diabetes. Diabetes Care Jan 2000; 23 (Suppl. 01) S55-S56
    PubMedGoogle Scholar
  • 13 Bakker K, Apelqvist J, Schaper NC. Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes Metab Res Rev Feb 2012; 28 (Suppl. 01) 225-231
    Google Scholar
  • 14 Perkins BA, Olaleye D, Zinman B et al. Simple screening tests for peripheral neuropathy in the diabetes clinic. Diabetes Care Feb 2001; 24: 250-256
    CrossrefPubMedGoogle Scholar
  • 15 Dros J, Wewerinke A, Bindels PJ et al. Accuracy of monofilament testing to diagnose peripheral neuropathy: a systematic review. Ann Fam Med Nov-Dec 2009; 7: 555-558
    CrossrefPubMedGoogle Scholar
  • 16 Jayaprakash P, Bhansali A, Bhansali S et al. Validation of bedside methods in evaluation of diabetic peripheral neuropathy. Indian J Med Res Jun 2011; 133: 645-649
    PubMedGoogle Scholar
  • 17 Lazaro-Martinez JL, Aragon-Sanchez FJ, Beneit-Montesinos JV et al. Foot biomechanics in patients with diabetes mellitus: doubts regarding the relationship between neuropathy, foot motion, and deformities. J Am Podiatr Med Assoc May-Jun 2011; 101: 208-214
    PubMedGoogle Scholar
  • 18 Quattrini C, Jeziorska M, Tavakoli M et al. The Neuropad test: a visual indicator test for human diabetic neuropathy. Diabetologia Jun 2008; 51: 1046-1050
    CrossrefPubMedGoogle Scholar
  • 19 Perkins BA, Orszag A, Ngo M et al. Prediction of incident diabetic neuropathy using the monofilament examination: a 4-year prospective study. Diabetes Care Jul 2010; 33: 1549-1554
    CrossrefPubMedGoogle Scholar
  • 20 Olaleye D, Perkins BA, Bril V. Evaluation of three screening tests and a risk assessment model for diagnosing peripheral neuropathy in the diabetes clinic. Diabetes Res Clin Pract Nov 2001; 54: 115-128
    CrossrefPubMedGoogle Scholar
  • 21 Astrom M, Arvidson T. Alignment and joint motion in the normal foot. J Orthop Sports Phys Ther Nov 1995; 22: 216-222
    CrossrefPubMedGoogle Scholar
  • 22 DiGiovanni CW, Kuo R, Tejwani N et al. Isolated gastrocnemius tightness. J Bone Joint Surg Am Jun 2002; 84-A: 962-970
    PubMedGoogle Scholar
  • 23 Oatis CA. Biomechanics of the foot and ankle under static conditions. Phys Ther Dec 1988; 68: 1815-1821
    PubMedGoogle Scholar
  • 24 Dananberg HJ. Functional hallux limitus and its relationship to gait efficiency. J Am Podiatr Med Assoc Nov 1986; 76: 648-652
    PubMedGoogle Scholar
  • 25 Michaud TC. Ideal Motions During the Gait Cycle. In: Foot Orthoses and Other Forms of Conservative Foot Care. Philadelphia: Lippincott Williams & Wilkins; 1993: 27
    Google Scholar
  • 26 Ferrari J, Higgins JP, Prior TD. WITHDRAWN: Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database Syst Rev 2009; (02) CD000964
    PubMedGoogle Scholar
  • 27 Schrier JC, Verheyen CC, Louwerens JW. Definitions of hammer toe and claw toe: an evaluation of the literature. J Am Podiatr Med Assoc May-Jun 2009; 99: 194-197
    PubMedGoogle Scholar
  • 28 Thomas JL, Blitch ELt, Chaney DM et al. Diagnosis and treatment of forefoot disorders. Section 4. Tailor’s bunion. J Foot Ankle Surg Mar-Apr 2009; 48: 257-263
    PubMedGoogle Scholar
  • 29 Bus SA, Yang QX, Wang JH et al. Intrinsic muscle atrophy and toe deformity in the diabetic neuropathic foot: a magnetic resonance imaging study. Diabetes Care Aug 2002; 25: 1444-1450
    CrossrefPubMedGoogle Scholar
  • 30 Bus SA, Maas M, Michels RP et al. Role of intrinsic muscle atrophy in the etiology of claw toe deformity in diabetic neuropathy may not be as straightforward as widely believed. Diabetes Care Jun 2009; 32: 1063-1067
    CrossrefPubMedGoogle Scholar
  • 31 Apelqvist J, Bakker K, van Houtum WH et al. Practical guidelines on the management and prevention of the diabetic foot: based upon the International Consensus on the Diabetic Foot (2007) Prepared by the International Working Group on the Diabetic Foot. Diabetes Metab Res Rev May-Jun 2008; 24 (Suppl. 01) S181-S187
    CrossrefPubMedGoogle Scholar