Since 2013 a fruitful cooperation between the Internal Medicine and Plastic surgery departments started to investigate lower extremity neuropathy in diabetic patients. In Franciscus Gasthuis hospital 416 patients were measured at the feet. The so-called Rotterdam Diabetic Foot Study is a prospective cohort study with annual measurements.
Important results from the study include the development of a validated grading scale of sensory function. Moreover, we were able to establish that non-invasive tests detect earlier sensory disturbances compared to the more frequently used tuning fork and 10 g monofilament.
With these results, we were able to grade lower extremity nerve function better, with fewer tests needed. Sensory status was found to relate to imbalance, risk of falls and also the risk of diabetic foot ulceration, allowing a more tailored made risk analysis with consequent recommendations.
From an epidemiologic study we concluded that 45% of diabetic subjects has signs of peripheral nerve entrapment at the tarsal tunnel. In this group of patients, it is possible to relieve neuropathy symptoms with (tibial) neurolysis. This type of surgery decompresses the increased pressure on the nerve, allowing nerve regeneration and reinnervating the insensate foot. Surgical outcomes of this type of surgery are further investigated in the randomized controlled DECO study, from which the RDF-study was the precursor.
