TY - JOUR
T1 - Plantar Ulcers and Neuropathic Arthropathies
T2 - Associated Diseases, Polyneuropathy Correlates, and Risk Covariates
AU - Andrews, Karen L.
AU - Dyck, Peter J.
AU - Kavros, Steven J.
AU - Vella, Adrian
AU - Kazamel, Mohamed
AU - Clark, Vicki
AU - Litchy, William J.
AU - James Dyck, P. B.
AU - Lodermeier, Karen A.
AU - Davies, Jenny L.
AU - Carter, Rickey E.
AU - Klein, Christopher J.
N1 - Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/4/1
Y1 - 2019/4/1
N2 - 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.
AB - 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.
KW - diabetes mellitus
KW - diabetic foot
KW - foot ulcer
KW - home monitoring
KW - neuropathic arthropathies
KW - neuropathy
KW - plantar ulcers
KW - prevention
KW - self-management
KW - skin stress
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U2 - 10.1097/01.ASW.0000550591.08674.98
DO - 10.1097/01.ASW.0000550591.08674.98
M3 - Article
C2 - 30624254
AN - SCOPUS:85063272146
SN - 1527-7941
VL - 32
SP - 168
EP - 175
JO - Advances in Skin and Wound Care
JF - Advances in Skin and Wound Care
IS - 4
ER -