The natural history of tarsal tunnel syndrome in diabetic subjects
Rinkel, Willem D; Castro Cabezas, Manuel; Birnie, Erwin; Coert, J Henk
(2020) Journal of Plastic, Reconstructive & Aesthetic Surgery, volume 73, issue 8, pp. 1482 - 1489
(Article)
Abstract
INTRODUCTION: Tibial nerve entrapment is highly prevalent in diabetic subjects, resulting in significantly more neuropathic complaints and concomitant sensory disturbances. The study aim was to assess the impact of tarsal tunnel syndrome (TTS) and sensory loss at baseline on incident diabetic foot ulceration (DFU) in diabetic patients, since decompressing the
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tibial nerve might change the natural history of the disease. METHODS: In this study, 113 subjects with TTS (69 bilateral, 23 left-sided and 21 right-sided) participating in the prospective Rotterdam Diabetic Foot Study were compared to 303 diabetic controls without TTS, regarding incident DFU. Kaplan-Meier analysis and Cox's regression analysis were used to determine the independent hazard of baseline variables for new DFU. RESULTS: The median observation period was 836.5 days (IQR, 459-1077.8). In bilateral TTS, 17.4% (95% CI: 8.4-26.3%) of subjects experienced DFU versus 8.3% (95% CI: 5.1-11.6%) in controls (left or right) during follow-up (p = 0.0036). In left-sided TTS, no subjects versus 6.2% (95% CI: 3.4-9.0%) in controls had DFUs (p = 0.243). Incident ulceration was seen in 14.3% (95% CI: -0.7% to -29.3%) of right-sided TTS subjects versus 4.1% (95% CI: 1.5-6.3%) in controls (p = 0.034). Besides HbA1c, diminished sensation at the hallux independently increased the risk of ulceration, in patients with (HR: 4.692, p = 0.003) and without (HR: 2.307, p = 0.002) prior DFU. DISCUSSION: Elevated sensory thresholds in TTS render diabetic patients at a higher risk for DFU. With effective surgery, TTS is likely to be an amenable factor to potentially prevent diabetic foot disease and thereby reduce amputation risk. LEVEL OF EVIDENCE: II.
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Keywords: Diabetic foot ulceration, Loss of sensation, Neuropathy, Tarsal tunnel syndrome, Tibial nerve entrapment, Prospective Studies, Sensory Thresholds, Humans, Middle Aged, Male, Disease Progression, Diabetic Foot/physiopathology, Tarsal Tunnel Syndrome/physiopathology, Netherlands, Female, Aged, Tibial nerve entrapnient, Surgery, Journal Article
ISSN: 1748-6815
Publisher: Churchill Livingstone
Note: Funding Information: The support for the RDF study was partially provided by Nuts Ohra Fund, the Netherlands, a nonprofit organization providing financial aid for medical research [grant no. 1002-042]. Nuts Ohra did not have any influence on the design, analysis, or interpretation of this study. Funding Information: The support for the RDF study was partially provided by Nuts Ohra Fund , the Netherlands, a nonprofit organization providing financial aid for medical research [grant no. 1002-042 ]. Nuts Ohra did not have any influence on the design, analysis, or interpretation of this study. Publisher Copyright: © 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons
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