Nerve conduction study of medial plantar and lateral plantar in Type 2 diabetes mellitus patients without sensory symptoms visiting a tertiary care hospital

Diabetic peripheral neuropathy is one of the most common long-term complications of diabetes mellitus and is the main initiation factor for foot ulceration and lower extremity amputation. Proper detection is important because once these changes begin, no known treatment can arrest, prevent or slow the development of neuropathy. Current guidelines suggest that a combination of symptoms, signs, and electrophysiologic measurements provide the most accurate diagnosis. The neuropathic changes may develop well before symptoms are manifested and objective tests which can identify it during its early stages are of prime importance. Nerve conduction study (NCS) is considered the gold standard or a consistent indicator of neuropathy. The typical diabetic peripheral neuropathy is length-dependent and changes begin at the distal nerves affecting the sensory nerves of the lower extremities first. The standard NCS protocol involves sensory NCS of the lower extremity sensory nerves mainly the sural and superficial peroneal nerves along with motor NCS of the peroneal and tibial nerves. However, even with normal NCS findings from conventional studies, NCS changes are evident in the most distal portions of nerves - the lateral plantar and medial plantar nerves. These nerves are the distal nerve endings of the superficial peroneal, sural, and tibial nerves. Because routine NCSs do not assess these distal nerves, some studies have advocated the assessment of these nerves in those with normal NCS findings to increase the diagnostic sensitivity of NCSs. This study will be a screening tool to detect early diabetic neuropathy in diabetes mellitus patients without sensory symptoms.