Diabetic Sensory Neuropathy Effect on Ankle Joint Movement Perception
Format of Original
Archives of Physical Medicine and Rehabilitation
Objective: To determine if diabetic subjects with lower extremity cutaneous sensory neuropathy also have a loss of ankle joint movements of ankle joint movement perception and measures of cutaneous sensory function was also investigated.
Design: Diabetic subjects with and without sensory neuropathy and individuals without diabetes participated in this study.
Setting: All subjects were community-living individuals.
Participants: Fifty-one subjects, ages 40 to 68. Seventeen of the 34 subjects with diabetes had significant distal sensory neuropathy as determined by cutaneous perception of mechanical vibration. All individuals without diabetes were volunteers from the community. Most subjects with diabetes were recruited through direct referral from their physicians.
Interventions: Ankle joint movement perception threshold (JMPT) was assessed using a device designed for this study. Cutaneous sensory function under both halluces was measured for vibration perception using a vibrometer and for touch-pressure perception using Semmes-Weinstein monofilaments.
Main Outcome Measures: Ankle JMPTs (degrees) were compared to measurements of cutaneous vibration perception (volts) and touch-pressure perception (monofilaments force ratings).
Results: Diabetic subjects with cutaneous sensory neuropathy demonstrated a significant loss of ankle movement perception (p < .01). Correlation between JMPT and cutaneous sensory tests ranged from Spearman's rank r = .43 to .67.
Conclusions: Although individuals with cutaneous sensory loss secondary to diabetic neuropathy also demonstrated loss of movement perception at the ankle, the relatively low explained variance between the two types of assessment (18% to 45%) indicates that the severity of ankle joint movement perception deficits cannot be directly implied from cutaneous sensory tests.