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被疼痛性糖尿病性多发性神经病变掩盖的跗管综合征

Tarsal tunnel syndrome masked by painful diabetic polyneuropathy.

作者信息

Ormeci Tugrul, Mahirogulları Mahir, Aysal Fikret

机构信息

Medipol University, Faculty of Medicine, Department of Radiology, İstanbul, Turkey.

Medipol University, Faculty of Medicine, Department of Orthopedics and Traumatology, İstanbul, Turkey.

出版信息

Int J Surg Case Rep. 2015;15:103-6. doi: 10.1016/j.ijscr.2015.08.033. Epub 2015 Aug 28.

Abstract

INTRODUCTION

Various causes influence the etiology of tarsal tunnel syndrome including systemic diseases with progressive neuropathy, such as diabetes.

PRESENTATION OF CASE

We describe a 52-year-old male patient with complaints of numbness, burning sensation and pain in both feet. The laboratory results showed that the patient had uncontrolled diabetes, and the EMG showed distal symmetrical sensory-motor neuropathy and nerve entrapment at the right. Ultrasonography and MRI showed the cyst in relation to medial plantar nerve, and edema- moderate atrophy were observed at the distal muscles of the foot.

DISCUSSION

Foot neuropathy in diabetic patients is a complex process. So, in planning the initial treatment, medical or surgical therapy is selected based on the location and type of the pathology. Foot deformities can be corrected with resting, anti-inflammatory treatment, appropriate shoes, orthesis and socks, and if required, ankle stabilization can be attempted. If the patient is still unresponsive, surgical treatment may be applied.

CONCLUSION

It is essential to investigate more localized reasons like tarsal tunnel syndrome that may mimic diabetic neuropathy, should be treated primarily.

摘要

引言

多种原因影响跗管综合征的病因,包括伴有进行性神经病变的全身性疾病,如糖尿病。

病例介绍

我们描述了一名52岁男性患者,主诉双足麻木、烧灼感和疼痛。实验室检查结果显示该患者患有未得到控制的糖尿病,肌电图显示远端对称性感觉运动神经病变及右侧神经卡压。超声和磁共振成像显示与足底内侧神经相关的囊肿,且在足部远端肌肉观察到水肿及中度萎缩。

讨论

糖尿病患者的足部神经病变是一个复杂的过程。因此,在规划初始治疗时,根据病变的部位和类型选择药物或手术治疗。足部畸形可通过休息、抗炎治疗、合适的鞋子、矫形器和袜子进行矫正,如有必要,可尝试进行踝关节稳定术。如果患者仍无反应,可采用手术治疗。

结论

必须调查可能模仿糖尿病神经病变的更局部的原因,如跗管综合征,应首先进行治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/756d/4601976/ad14c63aa2f4/gr1.jpg

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