TY - JOUR
T1 - The natural history of tarsal tunnel syndrome in diabetic subjects
AU - Rinkel, Willem D
AU - Castro Cabezas, Manuel
AU - Birnie, Erwin
AU - Coert, J Henk
N1 - Funding Information:
The support for the RDF study was partially provided by Nuts Ohra Fund, the Netherlands, a nonprofit organization providing financial aid for medical research [grant no. 1002-042]. Nuts Ohra did not have any influence on the design, analysis, or interpretation of this study.
Funding Information:
The support for the RDF study was partially provided by Nuts Ohra Fund , the Netherlands, a nonprofit organization providing financial aid for medical research [grant no. 1002-042 ]. Nuts Ohra did not have any influence on the design, analysis, or interpretation of this study.
Publisher Copyright:
© 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons
PY - 2020/8
Y1 - 2020/8
N2 - INTRODUCTION: Tibial nerve entrapment is highly prevalent in diabetic subjects, resulting in significantly more neuropathic complaints and concomitant sensory disturbances. The study aim was to assess the impact of tarsal tunnel syndrome (TTS) and sensory loss at baseline on incident diabetic foot ulceration (DFU) in diabetic patients, since decompressing the tibial nerve might change the natural history of the disease.METHODS: In this study, 113 subjects with TTS (69 bilateral, 23 left-sided and 21 right-sided) participating in the prospective Rotterdam Diabetic Foot Study were compared to 303 diabetic controls without TTS, regarding incident DFU. Kaplan-Meier analysis and Cox's regression analysis were used to determine the independent hazard of baseline variables for new DFU.RESULTS: The median observation period was 836.5 days (IQR, 459-1077.8). In bilateral TTS, 17.4% (95% CI: 8.4-26.3%) of subjects experienced DFU versus 8.3% (95% CI: 5.1-11.6%) in controls (left or right) during follow-up (p = 0.0036). In left-sided TTS, no subjects versus 6.2% (95% CI: 3.4-9.0%) in controls had DFUs (p = 0.243). Incident ulceration was seen in 14.3% (95% CI: -0.7% to -29.3%) of right-sided TTS subjects versus 4.1% (95% CI: 1.5-6.3%) in controls (p = 0.034). Besides HbA1c, diminished sensation at the hallux independently increased the risk of ulceration, in patients with (HR: 4.692, p = 0.003) and without (HR: 2.307, p = 0.002) prior DFU.DISCUSSION: Elevated sensory thresholds in TTS render diabetic patients at a higher risk for DFU. With effective surgery, TTS is likely to be an amenable factor to potentially prevent diabetic foot disease and thereby reduce amputation risk.LEVEL OF EVIDENCE: II.
AB - INTRODUCTION: Tibial nerve entrapment is highly prevalent in diabetic subjects, resulting in significantly more neuropathic complaints and concomitant sensory disturbances. The study aim was to assess the impact of tarsal tunnel syndrome (TTS) and sensory loss at baseline on incident diabetic foot ulceration (DFU) in diabetic patients, since decompressing the tibial nerve might change the natural history of the disease.METHODS: In this study, 113 subjects with TTS (69 bilateral, 23 left-sided and 21 right-sided) participating in the prospective Rotterdam Diabetic Foot Study were compared to 303 diabetic controls without TTS, regarding incident DFU. Kaplan-Meier analysis and Cox's regression analysis were used to determine the independent hazard of baseline variables for new DFU.RESULTS: The median observation period was 836.5 days (IQR, 459-1077.8). In bilateral TTS, 17.4% (95% CI: 8.4-26.3%) of subjects experienced DFU versus 8.3% (95% CI: 5.1-11.6%) in controls (left or right) during follow-up (p = 0.0036). In left-sided TTS, no subjects versus 6.2% (95% CI: 3.4-9.0%) in controls had DFUs (p = 0.243). Incident ulceration was seen in 14.3% (95% CI: -0.7% to -29.3%) of right-sided TTS subjects versus 4.1% (95% CI: 1.5-6.3%) in controls (p = 0.034). Besides HbA1c, diminished sensation at the hallux independently increased the risk of ulceration, in patients with (HR: 4.692, p = 0.003) and without (HR: 2.307, p = 0.002) prior DFU.DISCUSSION: Elevated sensory thresholds in TTS render diabetic patients at a higher risk for DFU. With effective surgery, TTS is likely to be an amenable factor to potentially prevent diabetic foot disease and thereby reduce amputation risk.LEVEL OF EVIDENCE: II.
KW - Diabetic foot ulceration
KW - Loss of sensation
KW - Neuropathy
KW - Tarsal tunnel syndrome
KW - Tibial nerve entrapment
KW - Prospective Studies
KW - Sensory Thresholds
KW - Humans
KW - Middle Aged
KW - Male
KW - Disease Progression
KW - Diabetic Foot/physiopathology
KW - Tarsal Tunnel Syndrome/physiopathology
KW - Netherlands
KW - Female
KW - Aged
KW - Tibial nerve entrapnient
UR - http://www.scopus.com/inward/record.url?scp=85082850181&partnerID=8YFLogxK
U2 - 10.1016/j.bjps.2020.02.033
DO - 10.1016/j.bjps.2020.02.033
M3 - Article
C2 - 32276769
SN - 1748-6815
VL - 73
SP - 1482
EP - 1489
JO - Journal of Plastic, Reconstructive & Aesthetic Surgery
JF - Journal of Plastic, Reconstructive & Aesthetic Surgery
IS - 8
ER -