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Foot & Ankle Specialist
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Characteristics of Lower Extremity Pressure Sensation Impairment in Developing Diabetic Sensory Polyneuropathy

Andrew J. Rader, DPM

Timothy P. Barry, DPM

Otis L. Stanley, DrPH

The medical literature presents diabetic sensory polyneuropathy as a length-dependent process producing a stocking distribution of sensory loss in the lower extremities. If a purely length-dependent etiology for diabetic sensory polyneuropathy were true, then a validated comparison of sensory loss at any equidistant site about the forefoot will reveal findings consistent with the accepted stocking pattern of anesthesia. A single-blinded, age-matched, control/experimental study is made into the frequency of apparent purely length-dependent A-beta fiber pathology in developing diabetic sensory polyneuropathy. Control (n = 46) and experimental (n = 83) central US subjects are examined with a subjective neuropathy screening questionnaire, vibratory threshold, and single-point pressure threshold testing. There is a plantar predominant pattern (61.5%) of sensory loss in developing diabetic sensory polyneuropathy, even after adjusting for sensitivity differences between different areas of the foot. A typical stocking pattern of sensory loss was not found. Although axonal pathology is length dependent, it is not apparently a purely length-dependent process. Therefore, a purely metabolic explanation for sensory loss is unlikely. In addition, an anatomic component for A-beta fiber pathology is implied by this study.

Key Words: neuropathy • stocking • length dependent • diabetes • sensory

Foot & Ankle Specialist, Vol. 1, No. 1, 39-45 (2008)
DOI: 10.1177/1938640007312383.
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