Pressure pain thresholds at the diabetic Charcot-foot: an exploratory study

Area of Science:

• Neurology
• Diabetology
• Pain Research

Background:

• Diabetic neuropathy can lead to painless trauma and neuroosteoarthropathy, commonly known as Charcot foot.
• Understanding pressure nociception in the diabetic foot is crucial for managing this condition.

Purpose of the Study:

• To investigate and compare pressure pain perception thresholds in diabetic patients with and without neuropathy, and in healthy individuals.
• Specifically, to assess deep pressure pain thresholds (DPPPT) and cutaneous pressure pain thresholds (CPPPT) in the hands and feet.

Main Methods:

• The study involved 24 diabetic patients (11 with Charcot foot, 13 controls) and 20 healthy subjects.
• CPPPT was measured using calibrated monofilaments on skinfolds, and DPPPT was measured using an Algometer II® over specific muscles and joints in the hands and feet.

Main Results:

• At the feet, cutaneous pressure pain thresholds (CPPPT) were significantly elevated in Charcot foot patients (11/11) compared to neuropathic controls (6/13) and healthy subjects (2/20).
• Deep pressure pain thresholds (DPPPT) were similar across all groups at the feet, although in Charcot patients, DPPPT was higher over the metatarsophalangeal joint than over the hallucis longus muscle.
• Hand pressure pain thresholds were comparable between diabetic patients and healthy individuals.

Conclusions:

• Cutaneous pressure pain perception is markedly reduced in the diabetic neuropathic foot, particularly in cases of Charcot foot.
• Deep pressure pain perception at the foot is not significantly altered in diabetic neuropathy, suggesting a selective impairment of superficial sensory pathways.