• 1

    Adler AI, Boyko EJ, Ahroni JH, et al: Risk factors for diabetic peripheral sensory neuropathy: results of the Seattle Prospective Diabetic Foot Study. .Diabetes Care 20::1162. ,1997. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Dyck PJ, Kratz KM, Karnes JL, et al: The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. .Neurology 43::817. ,1993. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Bevilacqua NJ, Rogers LC, Malik RA, et al: Technique of the sural nerve biopsy. .J Foot Ankle Surg 46::139. ,2007. .

  • 4

    Grant IA: “Differential Diagnosis of Diabetic Neuropathies,” in Diabetic Neuropathy, 2nd Ed, ed by PJ Dyck, PK Thomas, p 415, WB Saunders, Philadelphia. ,1999. .

  • 5

    Neundoerfer B, Thomas PK: Diabetic Sensorimotor Neuropathy: Clinical Features, Thieme, Stuttgart. ,2003. .

  • 6

    Partanen J, Niskanen L, Lehtinen J, et al: Natural history of peripheral neuropathy in patients with non-insulin-dependent diabetes mellitus. .N Engl J Med 333::89. ,1995. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Roane DW, Griger DR: An approach to diagnosis and initial management of systemic vasculitis. .Am Fam Physician 60::1421. ,1999. .

  • 8

    Said G: Necrotizing peripheral nerve vasculitis. .Neurol Clin 15::835. ,1997. .

  • 9

    Ohkoshi N, Mizusawa H, Oguni E, et al: Sural nerve biopsy in vasculitic neropathies: morphometric analysis of the caliber of involved vessels. .J Med 27::153. ,1996. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Hawke SH, Davies L, Pamphlett R, et al: Vasculitic neuropathy: a clinical and pathological study. .Brain 114: (pt 5):2175. ,1991. .

  • 11

    Nishino H, DeRemee RA, Rubino FA, et al: Wegener’s granulomatosis associated with vasculitis of the temporal artery: report of five cases. .Mayo Clin Proc 68::115. ,1993. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Nishino H, Rubino FA, Parisi JE: The spectrum of neurologic involvement in Wegener’s granulomatosis. .Neurology 43::1334. ,1993. .

Neuropathy in Diabetes

Not a Knee-Jerk Diagnosis

Lee C. Rogers DPM1, Nicholas J. Bevilacqua DPM1, Rayaz A. Malik MBChB, MRCP, PhD2, and David G. Armstrong DPM, PhD3
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  • 1 Amputation Prevention Center, Broadlawns Medical Center, Des Moines, IA.
  • | 2 Cardiovascular Research Group, Division of Cardiovascular and Endocrine Sciences, Department of Medicine, Manchester Royal Infirmary and Manchester University, Manchester, England.
  • | 3 Center for Lower Extremity Ambulatory Research (CLEAR), Dr. William M. Scholl College of Podiatric Medicine, North Chicago, IL.
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Neuropathic symptoms in patients with diabetes occur commonly and are most often a consequence of the diabetes. Up to 10% of patients with diabetes and neuropathy have an etiology other than diabetes as a cause of their nerve dysfunction. Herein we present a case of vasculitic neuropathy initially misdiagnosed as diabetic neuropathy that led to separate amputations of two toes. This case emphasizes the importance of considering alternative, potentially treatable, causes of peripheral neuropathy in patients with diabetes. (J Am Podiatr Med Assoc 98(4): 322–325, 2008)

Corresponding author: Lee C. Rogers, DPM, Amputation Prevention Center, Broadlawns Medical Center, 1801 Hickman Rd, Des Moines, IA 50314. (E-mail: Lee.C.Rogers @gmail.com)