In a large cohort of people with DPN in the UK, 7% developed a diabetic foot after one year ( Abbott 1998).ĭPN is largely concerned with the feet and lower limbs, although in some severe cases the hands may also be affected ( Boulton 2005a Boulton 2005b). A prospective study with 7.5% participants diagnosed with DPN at baseline showed that the prevalence increased to 45% after 25 years of follow‐up ( Pfeifer 1995). Some evidence has shown that the prevalence of DPN among people with diabetes in the UK is estimated to be 50% ( Sugimoto 2000), while the World Health Organization estimate for the UK is 29% ( Wild 2001). Stage 3: late complications of clinical neuropathy Sensory loss is slight, but pain at night common Signs of reduced or absent sensation with absent reflexes No symptoms or numbness/deadness of feet reduced thermal sensitivity painless injury Painless with complete/partial sensory loss Minor sensory signs or even normal peripheral neurological examination May be associated with initiation of glycaemic therapy Appropriate referral patterns and examination led to a speedy resolution of the problem and unnecessary physical therapy visits.Positive symptomatology (increasing pain at night): burning, shooting, stabbing pains ± pins and needlesĪbsent sensation to several modalities and reduced or absent reflexes.I have never previously considered Gout as a condition that would cause pain in this way, but clinical findings did suggest that patient condition required additional follow up with the physician. The tuning fork test resulted in a false positive for a fracture.A complete physical therapy exam, in collaboration with other medical providers, lead to correct interventions for an atypical presentation of gout.He was prescribed medications and his symptoms began to significantly improve. However, they did diagnose him with Gout, a metabolic disease in which crystals form in the joints. He had Xrays of his foot and it had shown no fracture. I called his primary care physician and explained to him my results. I explained to him that there is some evidence to suggest that he may have fractured his foot. He was also quite tender with stretching his foot. The patient jumped off the table when I put the tuning fork on the base of the outside of his foot. The theory is that the vibration causes the two end of a fracture to vibrate and thus causing a severe pain response. Tuning forks (a two-pronged steel device used by musicians, which vibrates when struck to give a note of specific pitch) can be quite useful at identifying fractures and/or problems with the bone. His ankle was quite swollen and tender on the outside of his foot. He came to the office stating that his left ankle pain was really bothering him and he would like us to start physical therapy treatments. He was diagnosed with peroneal tendinitis and responded well to care very quickly. His right ankle was initially treated because it very painful and debilitating. This patient inspects roofs for an insurance company and spends a great deal of time walking on sloped surfaces. A male in his late 20’s stopped by the clinic with bilateral ankle pain.

Tuning fork test