Abstract
The sequence of diabetic sensory neuropathy, ulcer, infection, gangrene, and amputation generally captures more attention in practice as well as in literature. However, there has to be a component of motor neuropathy without which ulcers and its consequences to gangrene occur in substantial number than neuropathy alone. It is also now accepted that motor neuropathy can even precede diabetic sensory neuropathy. It means that motor neuropathic abnormalities also would be high in prevalence by which time the sensory neuropathic disturbances catch up known to be frequent. The first issue therefore is to recognize the concurrence of these two and its consequences. The affliction of motor component neuropathy of the hands in diabetes is least understood. Its detailed review with lower limb motor neuropathies will enhance its understanding of the clinicians.
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Notes
- 1.
From surgical anatomy point of view, the flexor hallucis longus tendon is in close proximity of first metatarsal head where most ulcers in diabetic foot occur and the infection spreads along the flexor hallucis longus tendon all the way up in the calf. Hence the entire flexor hallucis longus tendon has to be traced back in such cases and excised till one comes across a viable tendon portion.
- 2.
Once the sensory neuropathy appears with, before or after the motor neuropathy, the feet become insensate and the person keeps walking even when an ulcer is formed since there is no pain. The ulcer then widens and deepens, serves as an entry point for infection and the subsequent complications. Most neuropathies in India and other less developed countries in South East Asia are sensory which thus adds to the burden of diabetic foot infections. Most ulcers begin small and should be taken care of, then the amputation rates will drastically come down (see the additional reading for all other details mentioned in other chapters).
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Kelkar, S. (2020). Motor Neuropathy and Diabetic Hand Syndrome. In: Diabetic Neuropathy and Clinical Practice. Springer, Singapore. https://doi.org/10.1007/978-981-15-2417-2_10
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