Effects of Physical Exercises on Peripheral Neuropathy Sensation in Patients with Type 2 Diabetes

Background - The most common complication in patients with type 2 diabetes is peripheral neuropathy. Physical exercise is one of the effective Prevention and treatment strategies of peripheral neuropathy in type 2 diabetes. Aims and objectives - The aim of this review articles is to describe the effectiveness of physical exercise on peripheral neuropathy sensation in patients with type 2 diabetes. Methods - A number of databases such as Science Direct, Springer Link, ProQuest, EBSCOhost, and Google Scholar were searched for relevant articles using keywords such as “type 2 diabetes”, AND “peripheral neuropathy sensation” OR “diabetes peripheral neuropathy" AND “physical exercises” OR “aerobic exercises” OR “resistance exercise”. All types of articles were included for the study, such as systematic reviews, randomized controlled trial, quasi-experiment, literature review, and pilot study with the range 2015-2020. Only articles in English are included in this review. Results - Of the 11 articles found, 9 articles showed that physical exercise had a direct effect on improving foot sensation in diabetic peripheral neuropathy patients, while the other 2 articles had an indirect effect on improving symptoms of peripheral neuropathy. Four types of physical exercise that are practiced in interventions are: aerobic exercise, resistance exercise, balance and flexibility exercise and a combination of two or more types of exercise. Physical exercise from low to moderate intensity has a positive effect on increasing foot sensation in patients with type 2 diabetes peripheral neuropathy. Conclusions – This review emphasizes the effect of physical exercise on peripheral neuropathic sensation in type 2 DM patients and strengthens the evidence that low and moderate-intensity exercise are beneficial to reduce peripheral neuropathy symptoms. Further research on the effectiveness of home and community-based physical exercise to reduce symptoms of peripheral neuropathy is necessary.

Vitamin D Deficiency in Patients with Diabetic Peripheral Neuropathy

Objective: To determine the frequency of vitamin D deficiency in patients presenting with diabetic peripheral neuropathyPatients and Methods: This cross sectional study was carried out in Department of Medicine and Neurology Indus Medical College, Tando Muhammad khan. from March 2017 to August 2017. Total 74 cases of Diabetes Mellitus presenting with peripheral diabetic neuropathy were selected for the study. Evolution of degree of Neuropathy was based on TCSS score as: {no neuropathy: ≤5, severe: ≥12, moderate: 9-11 and mild: 6-8}. Vitamin D level was categorized as (deficiency (0-20 ng/ml), insufficiency (21-30 ng/ml) sufficiency (>30 ng/ml), excess (>50 ng/ml) and toxicity (>100 ng/ml). All the data was entered in SPSS.Results: Total 74 patients with diabetic neuropathy were studied. Vast majority of patients 36(48.6%) were found in age group 51-60 years, Majority were males 45(60.8%). Most of the cases 35(47.3%) were with 1-3 years duration of neuropathy. Majority of patients 42(56.8%) were found with Mild peripheral neuropathy. Vitamin-D deficiency was present in 2(43.2%) cases and insufficiency was observed in 27(36.5%) cases. No significant association was found between vitamin D deficiency and severity of neuropathy.Conclusion: Vitamin D deficiency was found (43.2%) in patients of diabetic peripheral neuropathy. Vitamin screening and intake of supplement is necessary, will help to decrease the complication of peripheral neuropathy in Diabetic cases. Key words: Diabetes, Peripheral neuropathy, Vitamin D

Takedown of Ankle Fusions and Conversion to Total Ankle Replacements

Category: Ankle Introduction/Purpose: With ankle replacements gaining credibility there is a small subset of patients that might benefit from a conversion of an ankle fusion to a replacement. There is not much in the literature about conversions and we began this study without having any specific data regarding success and expectations we could provide to the patients. Our hypothesis was that for the correct indication a conversion of an ankle fusion to a total ankle replacement might do as well as a primary total ankle replacement. Methods: Twenty five patients presented to the senior author with either ongoing ankle pain after a fusion, or increasing pain after a period of relative comfort after an ankle fusion. All patients came specifically with the desire to discuss a conversion to an ankle replacement. Exclusion criteria included a history of Diabetes, peripheral neuropathy, excision of either malleoli at the time of fusion, pantalar fusion and neurovascular compromise. This study was conducted in compliance and approved with a local IRB. Outcomes were evaluated pre-operatively and post-operatively with the Veterans Rand Health Survey (VR-12), Ankle Osteoarthritis Scale (AOS), Visual Analog Scale (VAS) Pain scale and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score forms. A patient satisfaction survey was distributed to all patients and results were tabulated. Average follow up for outcome scores 23.77 months (range 4 – 74.78 months). Results: All ankle fusion conversions done at our center were included; no patients were lost to follow-up. Twenty-five patients(19 females) with the mean age of 63.7 months(36.55-75.83) were followed with a mean follow-up of 22.19 months(4–74.78 months). The mean AOFAS improved pre-operatively 26.25(8.0-56.0) to the latest follow-up of 78(77-100). VR-12 Mental improved from 52.24(34.81-72.46) to 56.13(28.4–72.31), and Physical 21.88(13.34-35.79) to 36.49(19.82-50.39) pre-operatively to post-operatively, respectively. The AOS Pain improved: 533.33(243-898) to the latest follow-up 215.86(15 -641); AOS Disability: 628.67(306-900) to the latest follow-up 221.64(2-612). Given patients have minimal to no dorsiflexion(DF) and plantarflexion(PF) with an ankle fusion, the range of motion increased with the affected ankle. Patients have a DF of 9.47degrees(2-15) and PF of 21.53degrees(12-35). Overall patients were satisfied with their results: 76.81/100. Conclusion: This is a small study with reasonable short follow-up, but the evidence show very satisfactory functional outcomes after a conversion of an ankle fusion to a total ankle replacement. Patient selection is extremely important. Long-term follow-up will show whether the longevity of these replacements compare to primary replacements.