Relationship Between Loss of Pedal Sensibility, Balance, + Falls in Patients With Peripheral Neuropathy

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Research from Ann Plast Surg. June 2004;52(6):535-540.

Relationship Between Loss of Pedal Sensibility, Balance, and Falls in

Patients With Peripheral Neuropathy.

Ducic I, Short KW, Dellon AL.

*Institute for Peripheral Nerve Surgery, Baltimore, land;

daggerDivision of Plastic Surgery, town University Hospital,

Washington, DC; double daggerSports Rehabilitation, Greater Chesapeake

Orthopedics, Union Memorial Hospital, Baltimore, land; and the

section signDivision of Plastic Surgery, s Hopkins University,

Baltimore, land.

The purpose of this study was to describe the relationship between

balance and foot sensibility in a population of patients with impaired

lower extremity sensation. The hypothesis was that increasing impairment

of sensation correlates with impaired balance.

To date, no report has investigated the relationship between loss of

balance with the degree of sensibility in the foot in a population with

neuropathy. Ten control subjects and 35 patients with sensory

abnormalities and balance problems related to a neuropathy were

evaluated. The MatScan Measurement System was used to measure their

ability to stand still, maintaining their balance with their eyes open

and then with their eyes shut.

The degree to which the person moves while attempting to stand still is

defined as " sway, " which was recorded for normal and neuropathy

patients. Sensibility of the foot was measured with the

Pressure-Specified Sensory Device, which is noninvasive and nonpainful.

The 1- and 2-point static touch thresholds are measured for the pulp of

the big toe, medial heel, and the dorsum of the foot. Loss of 2- or

1-point sensation was recorded as sensibility score and compared with

controls.

Statistical analysis of data and their comparisons for the 2 groups was

completed. There were 55% females in control and 64% in neuropathy

patients, whereas average age was 50 and 62 years, respectively.

Neuropathy was the result of diabetes in 64.5%, hypothyroidism in 19.3%,

their combination in 13%, and of unknown etiology in the remaining 19%

of patients. Controls had significantly lower mean sway than neuropathy

patients (22.9 +/- 9% vs. 189.5 +/- 180%, P = 0.006). Likewise,

sensibility score for normal and neuropathy patients was also

significantly different (31.4 +/- 9% vs. 232.8 +/- 59%, P <0.0001).

When compared with the controls, 99% upper limit of confidence,

sensibility in the neuropathy group at the hallux pulp was abnormal at a

level consistent with axonal loss in 52% and was completely absent in

the remaining 48%. Similarly, at the heel, sensibility was normal in

6.5%, abnormal at a level consistent with axonal loss in 71%, and absent

in the remaining 22.5%. The correlation coefficient between sway and

sensibility score was 0.36.

The results of this investigation for the first time document the

intuitive relationship between increasing loss of foot sensibility and

increasing loss of balance. These measurements can now be used

prospectively to evaluate whether restoration of sensation to patients

with neuropathy, through peripheral nerve decompression, can improve

balance and reduce falls/fractures in this patient population.