Footwear choice and the prevalence of peripheral neuropathy in a population-based sample of people with diabetes in Barbados

OBJECTIVE: To determine footwear choice and peripheral neuropathy prevalence in a population-based sample of people with diabetes in Barbados. DESIGN AND METHODS: A representative sample of the adult population (≥ 25yrs) was selected by multistage sampling. People with a previous diagnosis of diabetes or a single fasting blood glucose ≥ 7 mmol/L or HbA1c ≥ 6.5% completed a questionnaire. Examination for neuropathy included 10g monofilament testing at 4 plantar sites per foot, 128 Hz tuning fork and vibration perception threshold (VPT) biothesiometer testing at the hallux. RESULTS: Of 237 participants (71.8% response rate, 33% male, mean age 63.2 years, range 29.6 – 95.7 years, mean HbA1c 7.2%) 50.8% had a previous diagnosis of diabetes, 2 had amputations and 4 had foot ulcers. More men (67%) compared to women (29.7%) never wore footwear in the house (p<0.001), but 42.7% of the women vs. 18.2% men wore slippers (open back shoes) when attending the assessment centre. Most (57.7%) had symptoms of neuropathy by the UK symptom score, but only 7.6% by the slipping slipper sign. With 10g monofilament testing at 8 sites 23.6% (95% CI 18.2-29) 17.2%, 12.0% and 9.8% had a loss of sensation at ≥ 1,2,3 and 4 sites respectively. 9.3% (95% CI 5.6-13) had a VPT of ≥ 25V, and 12.7% (95% CI 8.4-17) did not detect the vibration of a tuning fork for at least one foot. CONCLUSIONS: Objectively detected neuropathy ranged from 9.3% to 23.6%, depending on the method, with foot complications risk being exacerbated by footwear choice.

Cutaneous larva migrans infection in the pediatric foot: a review and two case reports

Cutaneous larva migrans is the result of infestation of human skin by helminth larvae, which burrow through the epidermis. This route of infestation makes the foot a typical site for origination of this infection. Children, who frequently play barefoot in locations where the most common the helminth larvae, the dog and cat hookworms, are endemic, are at particular risk of this disorder. This article reviews the differential diagnosis of cutaneous larva migrans and current concepts in management. Two cases of related children who presented to their pediatricians with this condition are reported(AU)

Femoral neuropathy: a clinical review - abstract

Femoral neuropathy is a common cause of quadriceps wasting and weakness. The usual clinical picture involves pain and hyperaesthesia in the anteromedial aspect of the thigh, quadriceps weakness with muscle wasting and loss of the knee jerk. The present study reviews the aetiological factors, clinical features and prognosis in a group of 42 patients. Electrophysiological studies were performed in 33, and the condition graded as mild, moderate or severe. Diabetes mellitus was the commonest cause, but accident trauma, operative surgery, retroperitoneal haemorrhage and hyperglobinaemic states were other important associated conditions. A few palsies occurred spontaneously for no apparent reason. The symptom of pain alone was present in 14 cases. It was usually severe, often burning in character and located in the anterior thigh compartment. Weakness was the presenting feature in 15 patients who often complained of falling. In 16 patients pain and weakness were both present. The condition is usually unilateral, but bilateral involvement was seen in 4 diabetics, in one patient who suffered local trauma, and in one patient classified as idiopathic. In the acute stage when clinical paralysis appears to be complete electrophysiologic studies are a useful guide to outcome. Prognosis was good in the mild cases but delayed in severe cases. It is important that practitioners be aware of this condition, as unnecessary special examinations and operations may be avoided if the condition is correctly diagnosed (AU)

The alcoholic foot - abstract

The purpose of this study was the accurate definition and delineation of a syndrome of progressive necrosis of the feet seen in the Bahamian alcoholic. Seventeen cases were investigated and sufficient detail was obtained on 10 patients to justify some valid conclusions about the conditions. The results showed that all the patients in this series were male with an average of 44 years. On average they began to drink at 20 years and symptoms first appeared at about 36 years. In each case the amount of alcohol consumed was between 1 and 3 pints of spirit per day. All patients had a severe sensory peripheral neuropathy involving all modalities of sensation. The loss of sensation was invariably of the stocking type, and in each case the loss of temperature sensation extended more proximally than the loss of other types. The presence of alcoholic psychosis was almost invariable. The blood sugar and glucose tolerance tests were within normal limits, sickle cell preparations were negative, V.D.R.L.s were all negative and X-Rays of the feet in each case showed a characteristic lysis of the long bones of the feet. The conclusions to be drawn from this study are that there exists in the Bahamas a progressive necrosis of the feet identical in all respects with that described by French workers amongst alcoholic patients in the Loire Valley and that both Bahamian and French patients conform to the description of acrodystrophic neuropathy. The three classical features of acrodystrophic neuropathy are, trophic ulcers, extensive peripheral sensory loss and progressive necrosis of the long bones of the feet. The French also stressed the progressive nature of the condition alcoholic acrodystrophic neuropathy. The condition is associated with the consumption of more than a pint of spirit per day for many years and is not associated with evidence of any other disease of the central nervous system. The condition is predominantly a disease of males, there being no females in this series and only one in the French series. There is no evidence of vascular insufficiency and the condition would appear to be purely neuropathic in origin (AU)

Radiological changes associated with leg ulcers in the tropics

The radiological changes associated with four distinct types of leg ulceration common in the tropics are reviewed. Only mild changes occurred in the tropical phagedenic group, but more marked radiological abnormalities occurred in the three chronic groups. The frequency and pattern of the periosteal reaction is the most useful guide to radiological differentiation of these groups. (AU)