Neuropathy and gait disturbances in patients with venous disease: a pilot study.

Methods. After institutional review board approval and informed consent, 10 patients with active noninfected venous ulcers or a history of such ulcers (CEAP [ClinicalEtiologic-Anatomic-Pathophysiologic] clinical classification 5 or 6) were recruited. No recruited patient had a history of neuropathy or predisposing conditions for neuropathy. Ten age-, sex-, and weight-matched control patients without diabetes or venous disease were also recruited from the same population. All patients had good arterial circulation and walked without assistance. A medical history was obtained and foot, leg, and ulcer examinations were performed on all patients. To evaluate symptoms of peripheral sensory neuropathy, the validated neuropathy symptom score (NSS) was determined. To measure quantitative objective neuropathic changes, we performed quantitative sensory testing of the feet using the validated neuropathy disability score (NDS). As part of the NDS, we used a 10-g monofilament to perform sensory testing of the feet at 6 sites. Vibration perception threshold testing was performed using a biothesiometer and a 128-Hz tuning fork. Temperature discrimination and Achilles reflex were also tested. Gait was analyzed by evaluating pedal pressures using the Novel Emed program and device (Novel Electronics Inc, Minneapolis, Minnesota), an electronic measurement system used to evaluate dynamic pressure distributions. This device uses calibrated capacitive sensors beneath a mat connected to a computer to analyze pedal pressures as subjects walk across the mat barefoot. Overall pressure for each patient was measured in kilopascals (kPa), as were localized pressures in 5 locations on each foot.