Peripheral Neuropathy And Macro-Angiopathy In Diabetics With Foot Ulcers In Port Harcourt, Nigeria
AbstractOBJECTIVES: The study was aimed to determine the prevalence of peripheral neuropathy and macro-angiopathy among adult diabetic subjects with foot ulcer/gangrene in Port Harcourt, Nigeria.
METHODS AND MATERIALS: Fifty-one (51) consecutive diabetics with foot ulcer/gangrene admitted into the medical wards of the University of Port Harcourt Teaching Hospital (UPTH) between January 2002 and April 2003, were evaluated for symptom and signs of peripheral neuropathy. Symptoms and signs grades were assigned using a modification of the scoring system developed by Young et al (1993). Peripheral macro-vascular disease was assessed by palpation of the dorsalis pedis and posterior tibial arteries.
RESULTS: Thirty eight (74.5%) of the subjects had symptoms of peripheral neuropathy of mild to severe grades, and forty four (86.3%) had signs of neuropathy of mild to severe grades. Seven (13.7%) of the subjects had neither symptoms nor signs, while six (11.8%) had asymptomatic peripheral neuropathy. Overall, symptom and sign ratings showed poor agreement (Kappa Coefficient=0.335). The mean duration of diabetes was directly related only to symptoms grade (ANOVA p-value=0.02). Eighteen (35.3%) of the subjects had absence of either the dorsalis pedis or the posterior tibial pulses in the affected foot. Of these, 15 (83.3%) also had co-existing signs of peripheral neuropathy; the rest 3 (16.7%) had absent pulses only.
CONCLUSIONA high prevalence of peripheral neuropathy in diabetics with foot ulcers/gangrene was recorded. The study also revealed that peripheral vascular disease alone may not play a major role in the aetiology of diabetic foot ulceration; further strengthening the important role of peripheral neuropathy in the aetio-pathogenesis of diabetic foot ulcers. We recommend early screening for peripheral neuropathy, in addition to meticulous foot care, and improved glycaemic control.
KEY WORD: Peripheral neuropathy, Macro-angiopathy, Diabetic foot ulcers, Nigeria
Nigerian Journal of Orthopaedics and Trauma Vol.3(2) 2004: 214-224