1/40. osteomyelitis associated with peripheral vascular disease secondary to diabetes mellitus.diabetes mellitus and arteriosclerotic vascular disease have been found to be the predisposing factors of osteomyelitis associated with peripheral vascular disease (10). A diabetic person is more susceptible to osteomyelitis because of the microangiopathy, peripheral neuropathy and decreased resistance to infection. In diabetes mellitus there can be microangiopathy which results from the proliferation of the endothelium of the intima and thickening of the basement membrane. This further contributes to a sluggish blood flow. In the patient with arteriosclerotic vascular disease, the lumens of the arterioles and arterioles are compromised by the atheromatous plaques. The anatomic structure of the blood supply to bone along with the pathologic membrane thickening, allows for slowing of blood. This slowing of blood flow causes micro-thrombi and enhances bacterial growth. In diabetes mellitus it has been shown that there is a decreased immunologic response which, along with the above, contributes to the sheltering and proliferation of bacteria in the small bones of the foot.- - - - - - - - - - ranking = 1keywords = neuropathy (Clic here for more details about this article) |
2/40. Thermal burns in diabetic feet.Many patients with diabetes can lead a full life without developing diabetic lesions in their feet. This is because these patients have avoided the precipitating factors of which the most important is mechanical trauma and infections. We present five cases of diabetic patients who, out of ignorance, listened to bad advice by using hot therapy to treat their peripheral neuropathy. This resulted in burns and secondary infections. All of them required large surgical debridement and prolonged costly hospital stay to treat their condition. Fortunately, none of them required amputation. This paper hopes to highlight the dangers of self treatment and medication in diabetic foot lesions.- - - - - - - - - - ranking = 1keywords = neuropathy (Clic here for more details about this article) |
3/40. An unusual case of bilaterally symmetrical neuropathic osteoarthropathy of the midfoot as a result of lyme disease-induced peripheral neuropathy: a case report.The first known report of a patient with lyme disease-induced peripheral neuropathy resulting in bilaterally symmetrical "Charcot" changes of the midfoot is reported. An extensive review of the literature failed to produce any known cases of neuropathic osteoarthropathy that would be linked directly or indirectly with lyme disease-induced peripheral neuropathy. The relationship between lyme disease, the secondary neurologic manifestations caused by the infection, and neuropathic osteoarthropathy are discussed.- - - - - - - - - - ranking = 6keywords = neuropathy (Clic here for more details about this article) |
4/40. Neurilemoma of the medial plantar nerve: a case report.The incidence of neurilemoma in the foot is uncommon. Neurilemoma of the medial plantar nerve distal to the tarsal tunnel, with symptoms isolated to the foot, is rare. A case presentation of neurilemoma arising from the distal portion of the medial plantar nerve that was identified and excised is presented with a 19-month follow-up.- - - - - - - - - - ranking = 758.84630557526keywords = tarsal tunnel, tunnel (Clic here for more details about this article) |
5/40. Neurogenic positional pedal neuritis. Common pedal manifestations of spinal stenosis.Neurogenic positional pedal neuritis is a presentation of neuritic symptoms in one or both feet usually affected by body position, specifically, the position of the spine. Its etiology is similar to that of neurogenic-induced claudication caused by spinal stenosis in that the symptoms are caused by compression or irritation of nerves of the lower lumbosacral spine, usually the fifth lumbar and first sacral nerve roots. Burning, stabbing, a cold feeling, aching, numbness, paresthesia, or a weak or tired feeling of the feet (during some part of the disease process) depend on spinal position and may occur during standing, walking, or even lying in bed. Symptoms may be severe and are often eliminated by lumbosacral spine flexion, such as by walking with wheeled support such as a grocery cart or walker; less frequently by negative-heel shoe modification, which can change the position of the lumbosacral spine in stance; or by alteration of sleeping position. This condition, which can include loss of protective sensation, is often misdiagnosed as neuropathy (especially in diabetic patients) or less frequently as biomechanical in origin. In diabetic patients, this condition is frequently the cause of failure of monochromatic infrared energy therapy for diabetic peripheral neuropathy. Treatment is aimed at reducing the spinal nerve or nerve root irritation. Clear definition of the pedal symptoms of spinal nerve compression within a single diagnostic category should facilitate identification and treatment.- - - - - - - - - - ranking = 2keywords = neuropathy (Clic here for more details about this article) |
6/40. tarsal tunnel syndrome secondary to neurilemmoma.neurilemmoma is an uncommon cause of tarsal tunnel syndrome, and no other cases of this disorder secondary to a lesion at the bifurcation of the medial and lateral plantar nerves have been described. In this case, a 2 x 0.5 x 1-cm mass was palpable on physical examination, and, after failed conservative treatment, surgical excision brought prompt relief of symptoms.- - - - - - - - - - ranking = 898.19703108847keywords = tarsal tunnel, tarsal tunnel syndrome, tunnel, tunnel syndrome (Clic here for more details about this article) |
7/40. Long current impulses may be required for nerve stimulation in patients with ischemic pain.PURPOSE: To report on the efficacy of peripheral plexus catheters in the treatment of ischemic pain in spite of nerve stimulation with long current impulses. CLINICAL FEATURES: Two patients with severe neuropathic ischemic foot pain are described. A 56-yr-old man with diabetes, renal failure, and autonomic neuropathy presented with severe ischemic foot pain. Opioids produced excess sedation and hypotension. A 62-yr-old woman was admitted after femoral-popliteal bypass and developed a reperfusion pain syndrome not relieved with opioids, gabapentin, amitryptiline, and clonidine. In both patients, a sciatic plexus catheter was placed with resolution of pain. Conventional nerve stimulation, which uses a pulse duration of 0.1 msec, did not result in muscle contraction. However, by using a nerve stimulator capable of delivering a 1.0 msec impulse duration, a muscle twitch or paresthesia endpoint ensued allowing for successful catheter placement. CONCLUSION: Peripheral plexus catheters provide a safe alter-native to systemic analgesics for pain relief in patients with ischemic foot pain. However, conventional nerve stimulation techniques may not elicit a motor response in patients with underlying neuropathy, and the use of nerve stimulators capable of delivering long current impulses is recommended.- - - - - - - - - - ranking = 2keywords = neuropathy (Clic here for more details about this article) |
8/40. [Charcot foot treated by correction and arthrodesis of the hindfoot]THE PROBLEM: First patient: neuropathic osteoarthropathy with severely deformed foot, plantar ulceration and recurrent purulent infections. Second patient: diabetic osteoarthropathy with pathologic fracture. CLINICAL FINDINGS: First patient: 50-year-old man with hereditary sensory and motor neuropathy, plantar ulceration, equinus of the hindfoot, and extensive destruction of all bones of the foot. Recurrent infections necessitated repeated surgical interventions during the last 7 years. At the time of admission purulent infection of the foot. Healing after debridement including a resection of metatarsal bones and part of sequestrated bones of the foot. Patient was left with a severe equinus of the hindfoot. TREATMENT OPTIONS: Orthopedic shoes with or without below-knee orthesis. Lengthening of the achilles tendon and plantar alignment of the calcaneus. arthrodesis of the hindfoot. Below-knee amputation, if necessary as a primary procedure to combat infection. THE SOLUTION: arthrodesis of the hindfoot after realignment; an amputation of the foot was refused. SURGICAL TECHNIQUE: Two-stage procedure: treatment of infection followed by astragalectomy and tibiocalcaneal arthrodesis achieved with cancellous lag screws. Bridging of the area of resection with a segment of the fibula. RESULT: Bony fusion and full load bearing in an orthopedic shoe after 3 months. recurrence of ulcerations after 20 and 27 months due to wear of ill-fitting shoes. The accompanying purulent process forced the authors to resort to a below-knee amputation and fitting of a prosthesis. Second patient: of this patient only radiographs with a retrograde introduced intramedullary nail are shown.- - - - - - - - - - ranking = 1keywords = neuropathy (Clic here for more details about this article) |
9/40. Malignant degeneration of benign neurofibroma.Neurofibromas in the lower extremity are very uncommon, and malignant degeneration of these lesions is extremely rare. The authors present this case involving a malignant schwannoma (neurofibroma) located proximal to the tarsal tunnel with attachments to the achilles tendon. The diagnosis was made after extensive pathologic evaluation.- - - - - - - - - - ranking = 758.84630557526keywords = tarsal tunnel, tunnel (Clic here for more details about this article) |
10/40. Current perception threshold in evaluating foot pain. Two case presentations.Two cases are reported in which patients presented with complaints of foot pain, and a clinical suspicion of radiculopathy was supported by current perception threshold testing. chiropractic manipulation of the lumbar spine resulted in alleviation of the lower extremity symptoms. Current perception threshold testing is a valuable neurologic testing modality that is noninvasive, nonaversive, and highly reliable for evaluation of sensory nerves where neuropathy is suspected. This technology has been described for evaluation of diabetic neuropathy, uremic screening, and alcohol and chemical toxicity. Additionally, current perception threshold is useful for evaluation of other neuropathies, such as carpal tunnel syndrome and other entrapment neuropathies. The authors encourage further investigation of this modality in the diagnosis and evaluation of peripheral neuropathy and unexplained foot pain secondary to spinal nerve impingement.- - - - - - - - - - ranking = 5.6500028429278keywords = tunnel, tunnel syndrome, neuropathy, entrapment (Clic here for more details about this article) |
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