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Plantar Ulcers and Neuropathic Arthropathies: Associated Diseases, Polyneuropathy Correlates, and Risk Covariates
Karen L Andrews1, Peter J Dyck, Steven J Kavros
1At Mayo Clinic, in Rochester, Minnesota, Karen L. Andrews, MD, is Associate Professor, Department of Physical Medicine & Rehabilitation; Peter J. Dyck, MD, is Roy E. and Merle Meyer Professor of Neuroscience, Division of Neuromuscular Medicine; Steven J. Kavros, DPM, FACCWS, is a Consultant Podiatrist, Department of Orthopedic Surgery; Adrian Vella, MD, is Professor of Medicine, Division of Endocrinology, Diabetes, Metabolism & Nutrition; Mohamed Kazamel, MB, BCh, is Assistant Professor of Neurology, Division of Neuromuscular Medicine; Vicki Clark, BA, CCRP, is a Clinical Researcher, Division of Neuromuscular Medicine; William J. Litchy, MD, is a Neurology Consultant, Division of Neuromuscular Medicine; P. James B. Dyck, MD, is a Neurologist, Division of Neuromuscular Medicine; Karen A. Lodermeier, is Clinical Research Coordinator, Division of Neuromuscular Medicine; Jenny L. Davies, BA, is a Statistical Programmer Analyst, Division of Neuromuscular Medicine; Rickey E. Carter, PhD, is Professor of Biostatistics, Division of Biomedical Statistics and Informatics; and Christopher J. Klein, MD, is a neurologist, Division of Neuromuscular Medicine. The authors have disclosed no financial relationships related to this article. Submitted May 23, 2018; accepted in revised form June 29, 2018.
Objective:
To evaluate the associated diseases, polyneuropathy correlates, and risk covariates of neuropathic plantar ulcers (PUs) and neuropathic arthropathies (NAs).
Design:
The authors conducted a retrospective, observational study over 3.5 years of 69 patients with neuropathy, NA, or PU seen in a wound clinic who also had a comprehensive neurologic evaluation and neurophysiologic testing. Comparisons were made to a population representative cohort of patients with diabetes mellitus (DM; n = 259).
Results:
Of the 69 wound clinic patients, 32 had PUs, 14 had NAs, and 23 had both. Of the 61 adequately assessed patients, 37 (61%) had DM, 22 (36%) had no known associated disease, and 2 (3%) had hereditary sensory and autonomic neuropathy. Of the 37 patients with DM, 35 had distal polyneuropathy, and 2 did not. In 22 patients with chronic idiopathic axonal polyneuropathy, 20 had distal polyneuropathy.
Conclusions:
Although DM was the disease most commonly associated with PUs and NAs, chronic hyperglycemia may not have been the major underlying risk factor. The major risk covariates are sensation loss from polyneuropathy, old age, obesity, repetitive foot injury, and inadequate foot care or treatment. Physicians and other healthcare providers can help by identifying patients at risk and instituting measures such as adequate foot care to decrease these risks.
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