The effect of polyneuropathy of unilaterally ulcerated diabetic foot

ABSTRACTThe Effect of Polyneuropathy in the Development of Unilaterally UlceratedDiabetic FootIn this study, polyneuropathy and autonomic neuropathy were investigated byelectrophysiological studies and these parameters were discussed whether predictive inthe development of unilateral ulcerated diabetic foot.Fifty-two diabetic patients with unilateral diabetic foot wound (31 females, 21males and mean age 58.5 years) were included in the study. Motor fibers were affected82 % while it was 85 % for sensorial fibers in the upper extremities, where motor fiberswere affected 90 % in the injured site, 79 % in the healthy site and sensorial fibers wereaffected bilaterally in the lower extremities. H reflex was affected 93.2 % in the injuredsite and 86.4 % in the healty site. F response of fibulary nerve was affected 98.2% in theinjured site and 96.2% in the healty site, F response of posterior tibial nerve wasaffected 96.2 % in the injured site and 91.2 % in the healty site. Sensorial fibers wereaffected more than motor fibers which was more prominent in the lower extremities.The severity of polyneuropathy detected in physical examination was similarwith the degree of polyneuropathy that was found in the nerve conduction studies. Theelectrophysiological data was statistically different among injured and healtyextremities (p< 0.005).Sympathetic skin response (SSR) was 54 % abnormal in the upper extremity and88 % in the lower extremity. This rate was seen to be higher in the lower extremity thanupper extremity for both verbal and painful stimuli. But there was no differencebetween the SSRs of injured and healty sites (p>0.05).When visual analog scale (VAS) values of pain and SSRs were compared, theincrease of VAS scores and autonomic failure were paralel, but this was not statisticallysignificant (p=0.105).Our data revealed that nerve conduction studies have an important value in theprediction of diabetic foot ulceration. By this way, development of ulceration may beprevented in documented diabetic neuropathy.Key words: Diabetes mellitus, polyneuropathy, electrophysiological studies, painthreshold.IX