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Our experience of reinnervation of sole in diabetic sensorimotor polyneuropathy: A chance to change the natural history of disease
Institution:1. Professor, and in Charge Plastic Surgery Unit, NSCB Government Medical College, Jabalpur MP, 482003, India;2. Professor and Head, Department of Surgery, NSCB Government Medical College, Jabalpur, MP, 482003, India;1. Emory University, Department of Orthopaedic Surgery, 59 Executive Park South, Suite 200, Atlanta, GA 30324, USA;1. Department of Trauma & Orthopaedics, King’s College Hospital, London, UK;2. Diabetic Foot Clinic, King’s College Hospital, London, UK;3. University of Southern Denmark, Denmark;1. Consultant Orthopaedic Surgeon, St Mary’s Orthopaedics, Portland, ME, USA;2. Consultant Orthopaedic Surgeon, University Hospital Lewisham, London, UK;3. Trauma & Orthopaedic Registrar, King’s College Hospital, London, UK;1. Department of Public Health, University of North Carolina at Charlotte, North Carolina, 28223, USA;2. Department of Health Services Research, University of North Carolina at Charlotte, North Carolina, 28223, USA
Abstract:Diabetic sensorimotor polyneuropathy (DSPN) is the commonest form of neuropathy which leads to insensate sole, diabetic foot ulcers (DFU) and its complications. We share our experience in recovery of sensation in the sole after prophylactic surgery such as nerve decompression (ND) or sensory neurotization by nerve transfer (NT) in patients having Diabetic sensorimotor polyneuropathy DSPN. 32 patients (46 feet) were selected for either nerve decompression or sensory neurotization depending upon presence or absence of Tinel’s sign at tarsal tunnel. At 6 month post-operatively perception of touch and pain recovered in all feet; temperature and pressure perception recovered in ~95% feet; average vibration perception threshold returned to normal range and 2-Point Discrimination came down significantly. There were no ulcers or amputation in operated limbs during follow up period of 6 months. Prophylactic surgery in the form of ND and NT can be offered with minimal complications which significantly improve sensations in the sole in selected cases of DSPN. These have the potential to improve the quality of life of patient and change the natural course of disease.
Keywords:Diabetic sensorimotor polyneuropathy  Sensory loss of sole  Foot ulcer  Nerve decompression  Sensory neurotization  Sensory recovery
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