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Evaluation of Peripheral Neuropathy of Unknown Origin in an Outpatient Foot and Ankle Practice.
Foot Ankle Int. 2015 Sep; 36(9):1058-63.FA

Abstract

BACKGROUND

The foot and ankle surgeon can see peripheral neuropathy in the treatment of foot and ankle conditions. The purpose of this study was (1) to evaluate the demographics and presenting complaints of patients diagnosed with idiopathic peripheral neuropathy during an examination by a foot and ankle surgeon and (2) to identify the type and frequency of subsequent diagnosis of medical causes of neuropathy.

METHODS

This was a retrospective study of patients diagnosed with idiopathic peripheral neuropathy in our practice between January 1997 and December 2008. Ninety-five patients were identified, and demographic data, presenting complaints, and medical comorbidities were extracted from the medical record. Examination findings of decreased sensation to Semmes Weinstein 5.07 monofilament testing were documented, and electromyogram and nerve conduction study results were reviewed when available. Laboratory values were noted, as were neurologic evaluations performed to diagnose medical conditions associated with peripheral neuropathy.

RESULTS

The most common presentation was foot pain, in 36 patients (38%). Ninety-one patients had Semmes Weinstein 5.07 monofilament testing, with loss of protective sensation reported in 75 of the 91 tested (82%). Only 30 of the 95 patients had electromyogram and nerve conduction study results available, with a test positive for peripheral neuropathy in 20 of the 30 tested. Thirty-two patients were evaluated by a neurologist. A specific cause was identified in 12 of the 32 seen by a neurologist. Of the total group of 95 patients, 31 patients (33%) were diagnosed with a condition that may be associated with peripheral neuropathy.

CONCLUSIONS

Thirty-three percent of the patients presenting to our clinic and given a diagnosis of idiopathic peripheral neuropathy were ultimately diagnosed with a medical cause of neuropathy-most commonly, diabetes. For those patients with idiopathic neuropathy, a spectrum of disease was encountered, including pain, ulcer, infection, and Charcot neuroarthropathy.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Klein SE
Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA kleins@wustl.edu.
Chu J
Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
McCormick JJ
Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA.
Johnson JE
Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA.

MeSH

AdultAgedAged, 80 and overAmbulatory CareArthropathy, NeurogenicDiabetes MellitusFemaleFoot UlcerHumansMaleMiddle AgedPainPeripheral Nervous System DiseasesPhysical ExaminationRetrospective StudiesSoft Tissue InfectionsYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25967255

Citation

Klein, Sandra E., et al. "Evaluation of Peripheral Neuropathy of Unknown Origin in an Outpatient Foot and Ankle Practice." Foot & Ankle International, vol. 36, no. 9, 2015, pp. 1058-63.
Klein SE, Chu J, McCormick JJ, et al. Evaluation of Peripheral Neuropathy of Unknown Origin in an Outpatient Foot and Ankle Practice. Foot Ankle Int. 2015;36(9):1058-63.
Klein, S. E., Chu, J., McCormick, J. J., & Johnson, J. E. (2015). Evaluation of Peripheral Neuropathy of Unknown Origin in an Outpatient Foot and Ankle Practice. Foot & Ankle International, 36(9), 1058-63. https://doi.org/10.1177/1071100715583352
Klein SE, et al. Evaluation of Peripheral Neuropathy of Unknown Origin in an Outpatient Foot and Ankle Practice. Foot Ankle Int. 2015;36(9):1058-63. PubMed PMID: 25967255.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of Peripheral Neuropathy of Unknown Origin in an Outpatient Foot and Ankle Practice. AU - Klein,Sandra E, AU - Chu,Jennifer, AU - McCormick,Jeremy J, AU - Johnson,Jeffrey E, Y1 - 2015/05/12/ PY - 2015/5/14/entrez PY - 2015/5/15/pubmed PY - 2016/6/3/medline KW - Charcot arthropathy KW - diabetes mellitus KW - foot pain KW - peripheral neuropathy SP - 1058 EP - 63 JF - Foot & ankle international JO - Foot Ankle Int VL - 36 IS - 9 N2 - BACKGROUND: The foot and ankle surgeon can see peripheral neuropathy in the treatment of foot and ankle conditions. The purpose of this study was (1) to evaluate the demographics and presenting complaints of patients diagnosed with idiopathic peripheral neuropathy during an examination by a foot and ankle surgeon and (2) to identify the type and frequency of subsequent diagnosis of medical causes of neuropathy. METHODS: This was a retrospective study of patients diagnosed with idiopathic peripheral neuropathy in our practice between January 1997 and December 2008. Ninety-five patients were identified, and demographic data, presenting complaints, and medical comorbidities were extracted from the medical record. Examination findings of decreased sensation to Semmes Weinstein 5.07 monofilament testing were documented, and electromyogram and nerve conduction study results were reviewed when available. Laboratory values were noted, as were neurologic evaluations performed to diagnose medical conditions associated with peripheral neuropathy. RESULTS: The most common presentation was foot pain, in 36 patients (38%). Ninety-one patients had Semmes Weinstein 5.07 monofilament testing, with loss of protective sensation reported in 75 of the 91 tested (82%). Only 30 of the 95 patients had electromyogram and nerve conduction study results available, with a test positive for peripheral neuropathy in 20 of the 30 tested. Thirty-two patients were evaluated by a neurologist. A specific cause was identified in 12 of the 32 seen by a neurologist. Of the total group of 95 patients, 31 patients (33%) were diagnosed with a condition that may be associated with peripheral neuropathy. CONCLUSIONS: Thirty-three percent of the patients presenting to our clinic and given a diagnosis of idiopathic peripheral neuropathy were ultimately diagnosed with a medical cause of neuropathy-most commonly, diabetes. For those patients with idiopathic neuropathy, a spectrum of disease was encountered, including pain, ulcer, infection, and Charcot neuroarthropathy. LEVEL OF EVIDENCE: Level IV, retrospective case series. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/25967255/Evaluation_of_Peripheral_Neuropathy_of_Unknown_Origin_in_an_Outpatient_Foot_and_Ankle_Practice_ DB - PRIME DP - Unbound Medicine ER -