Abstract

Comparison of Cross Sectional Area of Posterior Tibial Nerve in Diabetic Peripheral Neuropathy Patients with That of Healthy Controls Using High Resolution Ultrasonography - A Cross Sectional Comparative Descriptive Study from Bangalore

Author(s): Chandrashekar H.M.1, Mohan S.2, Srinivas M.R.3

BACKGROUND
Patients with diabetic peripheral neuropathy (DPN) suffer from numbness, burning
feet, lightning pain, and pins-and-needles sensations. Recently, High resolution
ultrasonography is commonly used for evaluation of peripheral nerve diseases
because of its easy availability, time saving and non-invasiveness of the procedure.
This study intended to compare the cross sectional area (CSA) of posterior tibial
nerve (PTN) in type 2 diabetic patients with peripheral neuropathy with that of
non-diabetic healthy adults using high resolution ultrasonography (HRU) and study
the role of increase in HbA1c level and severity of DPN comparing with CSA of
PTN.
METHODS
A cross sectional comparative descriptive study was conducted from November
2018 to May 2020 with 50 type 2 diabetic patients and 50 healthy adults. 50 type
2 diabetic patients, clinically diagnosed with DPN were analysed and using the
Toronto Clinical Neuropathy Score (TCNS) System, the severity of neuropathy was
determined. HbA1c level and other demographic data were collected. 50 healthy
adults were taken as controls. The CSA of posterior tibial nerve was measured 3
cm proximal to the medial malleolus in both lower limbs using HRU.
RESULTS
The mean CSA of posterior tibial nerve in healthy subjects was 6.0 + / - 0.142
mm2, and in diabetic patients with peripheral neuropathy was 11.77 + / - 0.291
mm2. Upon comparing the mean CSA of posterior tibial nerve of diabetic subjects
with peripheral neuropathy and control subjects were statistically significant (P <
0.001) in unpaired ‘t’ test. In our study, CSA of the posterior tibial nerve correlated
significantly with TCNS and HbA1c levels, at P < 0.001.
CONCLUSIONS
This study showed that there is a significant difference between the cross sectional
areas of posterior tibial nerve in diabetic subjects with peripheral neuropathy and
healthy adult subjects. HRU can detect cross sectional area changes in the
posterior tibial nerve early. Thus, ultrasonography can be used as a good screening
tool in these patients.