Dynamic Device for Diabetic Neuropathic Foot Screening

Diabetic peripheral neuropathy is the most common complication of diabetes mellitus. It progresses from initial sensorial functional stage to nerve fiber loss and results in pain, loss of sensation, foot ulcers, gangrene and amputations. Diabetic foot can be classified as neuropathic, neuroischemic, and ischemic.

Diabetic foot is responsible for most diabetes-related hospitalizations.

Neuropathic ulcers occur mostly on the plantar surface, as immediate result of autonomic neuropathy and angiopathy, in their turn caused by degeneration of thermo- and mechanoreceptors.

Diabetic neuropathies are a family of nerve disorders caused by diabetes. Prevalence of pain with neuropathic characteristics in the general population is 7%-8%.

60% to 70% of people with diabetes have some form of neuropathy.

Diabetic neuropathy can be divided into large and small fiber neuropathies. Warm sensations are conducted by C-fibers of peripheral nerves and cold sensations by small diameter A-delta and C-fibers. Impairment of pain, light touch and temperature is secondary to loss of small fibers. Loss of vibratory sensation and altered proprioception reflects large-fiber loss.

Patients with small-fiber neuropathy experience burning and shooting pain, patients with large-fiber neuropathy mostly have numbness and tingling in the feet.

Peripheral neuropathy in patients with diabetes mellitus increases risk of foot ulceration and diabetic foot 7-fold. More than 50% of the diabetes patients with foot ulceration have no symptoms of pain. Abnormal results on monofilament testing and vibratory perception are most useful in evaluation of patients with large-fiber peripheral neuropathy.

According to GD.Valk, neuropathic pain was only significantly associated with temperature discrimination thresholds for cold stimuli.

Several parameters of quantitative sensory and electrophysiological testing (e.g. vibration perception thresholds or nerve potential amplitudes) correlate closely with morphological findings such as nerve fiber density and may identify patients amenable to therapy.

Optimal metabolic control is the only available measure with proven efficacy in preventing or at least halting the progression of diabetic neuropathy. However, to be effective it should be instituted at an early stage since, as is the case with other late complications of diabetes, the late phases of diabetic neuropathy are poorly reversible or even irreversible.

Neuropathic pain adversely affect patients overall health-related quality of life… and associated with substantial societal cost. In the United States, more than 83,000 extremities are amputated yearly at a cost of more than $5 billion. Worldwide, 1 million lower extremity amputations are done for patients with diabetes. That's one every 30 seconds.

The U. S. Centers for Disease Control and Prevention estimates that up to 85% of these amputations can be prevented.

The mortality rate after limb amputation approaches 80% - a death rate second only to lung cancer (86%). The estimated cost of foot ulcer care in the US ranges from $4,595 per ulcer episode to more than $28,000, for the 2 years post diagnosis. The total annual cost of foot ulcer care in the US is high as $5 billion.