Diabetes Care, Vol 16, Issue 8 1187-1189, Copyright © 1993 by American Diabetes Association

ARTICLES

Painful neuropathy and foot ulceration in diabetic patients

A Veves, C Manes, HJ Murray, MJ Young and AJ Boulton
University Department of Medicine, Manchester Royal Infirmary, United Kingdom.

OBJECTIVE--To examine the prevalence of painful symptoms in neuropathic patients with or without foot ulceration. It has been suggested that there are two clinical presentations of sensory diabetic neuropathy with little overlap: painful (acute or chronic) and painless with recurrent foot ulceration. RESEARCH DESIGN AND METHODS--We examined three groups of diabetic patients matched for age and duration of diabetes--24 without neuropathy on clinical grounds (mean age 56.1 yr [range 38-76 yr], diabetes duration 12.6 yr [0.4-40 yr]), 30 with neuropathy (mean age 55.3 yr [range 21-73 yr], diabetes duration 17.3 yr [range 0.2-61 yr]), and 40 with neuropathic foot ulceration (mean age 58.1 yr [range 41-72 yr], diabetes duration 18.5 yr [range 1-46 yr])--and compared them with 20 healthy subjects (mean age 50 yr [range 37-69 yr]). For evaluation of neuropathy, the neuropathy symptom score, neuropathy disability score, and vibration perception threshold were measured. RESULTS--No difference existed between the neuropathic and foot ulcer groups in the neuropathy symptom score (4.2 +/- 3.9 [mean +/- SD] vs. 2.5 +/- 2.1, NS) and neuropathy disability score (15.1 +/- 5.7 vs. 16.8 +/- 6.1, NS), but the vibration perception threshold was lower in the neuropathic group (30.1 +/- 13.4 vs. 40.5 +/- 13.8 V, P < 0.001). Painful symptoms (neuropathy symptom score > 3), either in the past or during the time the study was conducted, had been experienced by none of the control subjects, 7 (29%) of the nonneuropathic group, 18 (60%) of the neuropathic group, and 17 (43%) of the foot ulcer group (NS for the last two groups), and were present at the time of examination in 13 (43%) of the neuropathic group and in 13 (33%) of the foot ulcer group (NS in all groups). Duration of symptoms was < 12 mo in 12 (40%) neuropathic and 15 (38%) foot ulcer patients (NS). CONCLUSIONS--We conclude that painful symptoms are frequent in diabetic neuropathy, irrespective of the presence or absence of foot ulceration and that these symptoms can occur at any stage of the disease. These results suggest that there is a spectrum of neuropathic syndromes from the painful to the patients with foot ulceration, and that much overlap exists.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				S. T.M. Krishnan, C. Quattrini, M. Jeziorska, R. A. Malik, and G. Rayman Neurovascular Factors in Wound Healing in the Foot Skin of Type 2 Diabetic Subjects Diabetes Care, December 1, 2007; 30(12): 3058 - 3062. [Abstract] [Full Text] [PDF]

				N. Papanas, K. Papatheodorou, D. Papazoglou, D. Christakidis, C. Monastiriotis, and E. Maltezos The New Indicator Test (Neuropad(R)): A Valuable Diagnostic Tool for Small-Fiber Impairment in Patients With Type 2 Diabetes The Diabetes Educator, March 1, 2007; 33(2): 257 - 266. [Abstract] [Full Text] [PDF]

				M. Davies, S. Brophy, R. Williams, and A. Taylor The Prevalence, Severity, and Impact of Painful Diabetic Peripheral Neuropathy in Type 2 Diabetes Diabetes Care, July 1, 2006; 29(7): 1518 - 1522. [Abstract] [Full Text] [PDF]

				S. T.M. Krishnan, N. R. Baker, A. L. Carrington, and G. Rayman Comparative Roles of Microvascular and Nerve Function in Foot Ulceration in Type 2 Diabetes Diabetes Care, June 1, 2004; 27(6): 1343 - 1348. [Abstract] [Full Text] [PDF]

				S. M. Cooper, D. Hofman, and S. M. Burge Leg Ulcers and Pain: A Review International Journal of Lower Extremity Wounds, December 1, 2003; 2(4): 189 - 197. [Abstract] [PDF]