Diagnosis and manipulative treatment in diabetic polyneuropathy and its relation to intertarsal joint dysfunction.
joint & mobility
To present the diagnosis and differential diagnosis of diabetic polyneuropathy and report a case in which a patient with this disorder was successfully managed utilizing chiropractic procedures.An 80-year-old man with a history of diabetes mellitus complained of low back pain along with burning pains in the lower extremities and poor balance. Disturbance of vibration, joint position, coarse and fine touch and pinprick sensation was found along with extensive trophic changes, mild motor weakness and absent Achilles reflexes. Joint dysfunction was detected in the mortise and intertarsal joints and myofascial trigger points were found in the quadratus plantae muscles.The patient was treated with manipulation to the intertarsal and mortise joints and myofascial therapy to the quadratus plantae muscles 18 times over 4 months. This treatment brought about dramatic improvement in both symptoms and clinical signs of nerve function.It is possible that joint and/or myofascial dysfunction may play a role in the susceptibility to diabetic polyneuropathy and that treatment of these dysfunctional conditions may bring about improvement in the neuropathy. Possible mechanisms by which this may occur include impaired afferent stimulation from the intertarsal joint receptors due to loss of joint play and disturbance of axoplasmic flow along the nerves affected by the neuropathy. Reporting similar cases as well as conducting clinical trials with large populations may shed light on whether there is a relationship between diabetic polyneuropathy and joint and myofascial dysfunction of the feet.