Lee CH, Kim TK, Yoon ES, et al: Correlation of high-resolution ultrasonographic findings with the clinical symptoms and electrodiagnostic data in carpal tunnel syndrome. .Ann Plast Surg54::20. ,2004. .
Lee CH, Kim TK, Yoon ES, et al: Correlation of high-resolution ultrasonographic findings with the clinical symptoms and electrodiagnostic data in carpal tunnel syndrome. .Ann Plast Surg54::20. ,2004. .)| false
Dellon AL: “Threshold versus Innervation Density,” in Somatosensory Testing and Rehabilitation, ed by D Stamm, p 82, Institute for Peripheral Nerve Surgery, Baltimore. ,2000. .
Lee D, Dauphinee DM, Bastawros D: Ultrasound evaluation of the tarsal tunnel in diabetic foot neuropathy. Paper presented at the 90th Scientific Session and Annual Meeting of the Radiological Society of North America, November 30. ,2004. , Chicago.
Martinoli C, Bianchi S, Pugliese F, et al: Sonography of entrapment neuropathies in the upper limb (wrist excluded). .J Clin Ultrasound32::438. ,2004. .
It has been hypothesized that in individuals with diabetes mellitus the peripheral nerve is swollen owing to increased water content related to increased aldose reductase conversion of glucose to sorbitol. It has further been hypothesized that the tibial nerve in the tarsal tunnel is at risk for chronic nerve compression related to this swelling. We used diagnostic ultrasound to evaluate this hypothesis. Cross-sectional areas of the tibial nerve were measured in diabetic patients with neuropathy and compared with previously reported measurements in nondiabetic patients and diabetic patients without neuropathy. We used the Pressure-Specified Sensory Device (Sensory Management Services LLC, Baltimore, Maryland) to document the presence of neuropathy in 24 diabetic patients (48 limbs). Previous studies have found that the cross-sectional area of the tibial nerve in nondiabetic patients and in diabetic patients without neuropathy is not significantly different. We found that the mean cross-sectional area of the tibial nerve in diabetic patients with neuropathy is significantly greater than that in diabetic patients without neuropathy (24.0 versus 12.0 mm2). Our study highlights the value of newer ultrasound imaging techniques in identifying morphological change in the tibial nerve and confirms that the tibial nerve in the tarsal tunnel is swollen, consistent with chronic compression, in diabetic patients with neuropathy. (J Am Podiatr Med Assoc 95(5): 433–437, 2005)
Corresponding author: Damien M. Dauphinée, DPM, Foot and Ankle Associates of North Texas LLP, 500 N Valley Pkwy, Ste 100, Lewisville, TX 75067.