The Rotterdam Diabetic Foot Study: A different view on lower extremity neuropathy: a new hope against the phantom menace?

The first reports from the Rotterdam Diabetic Foot (RDF) Study described in this thesis show that diabetes-induced sensory loss is gradable with simple to use instruments. This grading allows stratifying those at risk for postural imbalance, recurrent falls and ulceration and is a novel addition to the current literature. Moreover, our studies showed that tibial nerve anomalies are common in diabetic patients compared to the control population, and are accompanied with more neuropathic symptoms and sensory deficit. The latter places the feet with tarsal tunnel syndrome at higher risk for diabetic foot syndrome. Modeled outcomes based on current literature suggest that beneficial long-term effects of decompressing the lower extremity nerves are possible. The DECO study will confirm or refute these estimates, of which the RDF Study was an important predecessor in regard to the epidemiology of lower extremity complications of diabetes. Future studies are necessary to investigate whether optimal prevention, surveillance and treatment of lower extremity neuropathies leads to a reduction in the incidence of its complications, in which the results of the RDF Study may aid.