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Background: Diabetic neuropathy consists of multiple clinical manifestations of which loss of sensation is most prominent. High temperatures under the foot coupled with reduced or complete loss of sensation can predispose the patient to foot ulceration. The aim of this study was to look at the correlation between plantar foot temperature and diabetic neuropathy using a noninvasive infrared thermal imaging technique., Methods: Infrared thermal imaging, a remote and noncontact experimental tool, was used to study the plantar foot temperatures of 112 subjects with type 2 diabetes selected from a tertiary diabetes centre in South India., Results: Patients with diabetic neuropathy (defined as vibration perception threshold (VPT) values on biothesiometry greater than 20 V) had a higher foot temperature (32-35 °C) compared to patients without neuropathy (27-30 °C). Diabetic subjects with neuropathy also had higher mean foot temperature (MFT) (p=.001) compared to non-neuropathic subjects. MFT also showed a positive correlation with right great toe (r=0.301, p=.001) and left great toe VPT values (r=0.292, p=.002). However, there was no correlation between glycated hemoglobin and MFT., Conclusions: Infrared thermal imaging may be used as an additional tool for evaluation of high risk diabetic feet., (© 2010 Diabetes Technology Society.)

Background: Chronic neuropathic pain in leprosy patients after completion of multi-drug therapy (MDT) is an under-researched problem. The reason why some leprosy patients develop it is unknown. In this study we evaluated the role of ongoing inflammation and small-fibre neuropathy as possible contributing factors for neuropathic pain., Methods: We assessed chronic neuropathic pain in 17 leprosy patients who had completed MDT and were attending a referral clinic in Hyderabad, India. All patients had a clinical assessment, intraepidermal nerve (IENF) assessment and quantitative sensory testing (QST), which included the testing of tactile and pinprick sensations using Semmes-Weinstein monofilaments and weighted needles method. Nine patients had a sural nerve biopsy (SNB)., Results: Thirteen patients had a glove and stocking pattern of neuropathy. All nerve biopsies showed inflammation with intraneural inflammation and perineural thickening, and intraneural acid fast bacilli were observed in five biopsies. IENF analysis of the skin biopsy specimens in 16/17 patients showed a statistically significant reduction in IENF density (P < 0.001, Mann Whitney test) compared to control skin biopsies. Complete depletion of intraepidermal nerves was observed in six patients. QST also showed marked abnormalities. In 11 patients total sensory loss for all modalities was found, and in the other six patients the sensory function was seriously impaired., Discussion: There is evidence of ongoing intraneural inflammation in leprosy patients who have completed MDT. This may explain the occurrence of chronic neuropathic pain. Using IENF density measurement we have found significant small-fibre neuropathy in leprosy patients and the use of this tool could be expanded.

The present study attempts to determine the cutaneous pattern of distribution of the sural nerve on the dorsum of the foot to note the predominant pattern present and whether there was any association between the innervation pattern and sex or side. A total of 260 Indian feet (78 adult feet: 60 male, 18 female; 52 fetal feet: 20 male, 32 female) were dissected. The results showed six patterns of innervation of the toes by the sural nerve. In Type I, the lateral side of the little toe was supplied by the sural nerve alone and the adjacent sides of the 2nd, 3rd, 4th, and 5th toes by the superficial peroneal nerve alone (35.38%). In Type II the lateral side of the little toe was supplied by the sural nerve alone and the adjacent sides of the 4th and 5th toes by the sural nerve along with the superficial peroneal nerve (10%). In Type III the lateral side of the little toe was supplied by the sural nerve alone and the adjacent sides of the 3rd, 4th, and 5th toes by the sural nerve along with the superficial peroneal nerve (21.15%). In Type IV the lateral 1(1/2) toes were supplied by the sural nerve alone and the adjacent sides of the 3rd and 4th toes by the superficial peroneal nerve alone (3.85%). In Type V the lateral 1(1/2) toes were supplied by the sural nerve alone and the adjacent sides of the 3rd and 4th toes were supplied by the sural nerve along with the superficial peroneal nerve (5%). In Type VI the lateral 2(1/2) toes were supplied by the sural nerve alone (24.61%). The predominant patterns were Type I (35.38%), Type VI (24.61%), and Type III (21.15%). There was no association between the innervation pattern of the sural nerve and sex or side. The pattern, which is usually described, was found in only 35.38% of feet. Considering the variation in the pattern of cutaneous distribution of the sural nerve in Indian feet, the function of the sural nerve may be to supply a wider area of skin than is usually described., ((c) 2005 Wiley-Liss, Inc.)

Regular testing for impaired sensation is important in the management of diseases that can cause progressive nerve damage, such as leprosy. It has been shown that light touch sensibility decreases with age in the hands of healthy individuals, but little research has been undertaken to assess possible changes in the feet in developing countries. This information is needed to allow an appropriate level of sensation to be chosen when screening for nerve damage in the foot. To clarify this, a cross-sectional study on male adults was carried out in the rural town of Salur, Andhra Pradesh, India. A range of Semmes-Weinstein monofilaments were employed at 12 locations on the foot to determine sensation to light touch stimuli in individuals from each decade of adult life. It was found that in this population, sensibility threshold in the foot increases with age and this was noted in both soft and callous skin. This shows the increase was due to neurological factors, not merely due to an increase in callous deposition with advancing age. In the majority of individuals in their fifties and sixties, the callous skin at the forefoot and heel was unable to detect the 5.07 monofilament (equivalent to 8-12 g), previously recommended as a method to screen for plantar neuropathy. All areas of all feet were able to detect the 5.46 filament (approximately 30 g). The size of this study (54 individuals) prevents the determination of definitive normal ranges for each decade of life in this population. However, it does demonstrate the degree to which sensation deteriorates with age and could be used as an approximate guide when interpreting the results of sensory testing in similar rural areas of the developing world.