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Pressure pain perception in the diabetic Charcot foot: facts and hypotheses

BACKGROUND: Reduced traumatic and posttraumatic (nociceptive) pain is a key feature of diabetic neuropathy. Underlying condition is a gradual degeneration of endings of pain nerves (A-delta fibers and C-fibers), which operate as receivers of noxious stimuli (nociceptors). Hence, the absence of A-del...

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Autores principales: Chantelau, Ernst A., Wienemann, Tobias
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Co-Action Publishing 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661900/
https://www.ncbi.nlm.nih.gov/pubmed/23705057
http://dx.doi.org/10.3402/dfa.v4i0.20981
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author Chantelau, Ernst A.
Wienemann, Tobias
author_facet Chantelau, Ernst A.
Wienemann, Tobias
author_sort Chantelau, Ernst A.
collection PubMed
description BACKGROUND: Reduced traumatic and posttraumatic (nociceptive) pain is a key feature of diabetic neuropathy. Underlying condition is a gradual degeneration of endings of pain nerves (A-delta fibers and C-fibers), which operate as receivers of noxious stimuli (nociceptors). Hence, the absence of A-delta fiber mediated sharp pain (“first” pain), and of C-fiber mediated dull pain (“second” pain). However, patients with diabetic neuropathy and acute Charcot foot often experience deep dull aching in the Charcot foot while walking on it. AIM: To create a unifying hypothesis on the kind of pain in an acute Charcot foot. RESULT: Absence of punctuate (pinprick) pain perception at the sole of a Charcot foot, as was shown recently, likely corresponds to vanished intraepidermal A-delta fiber endings. C-fiber nociceptors are reduced, according to histopathology studies. Both types of fibers contribute to posttraumatic hyperalgesia at the skin level, as studies show. Their deficiencies likely impact on posttraumatic hyperalgesia at the skin level and, probably, also at the skeletal level. CONCLUSION: It is hypothesised that deep dull aching in an acute diabetic Charcot foot may represent faulty posttraumatic hyperalgesia involving cutaneous and skeletal tissues.
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spelling pubmed-36619002013-05-23 Pressure pain perception in the diabetic Charcot foot: facts and hypotheses Chantelau, Ernst A. Wienemann, Tobias Diabet Foot Ankle Perspectives BACKGROUND: Reduced traumatic and posttraumatic (nociceptive) pain is a key feature of diabetic neuropathy. Underlying condition is a gradual degeneration of endings of pain nerves (A-delta fibers and C-fibers), which operate as receivers of noxious stimuli (nociceptors). Hence, the absence of A-delta fiber mediated sharp pain (“first” pain), and of C-fiber mediated dull pain (“second” pain). However, patients with diabetic neuropathy and acute Charcot foot often experience deep dull aching in the Charcot foot while walking on it. AIM: To create a unifying hypothesis on the kind of pain in an acute Charcot foot. RESULT: Absence of punctuate (pinprick) pain perception at the sole of a Charcot foot, as was shown recently, likely corresponds to vanished intraepidermal A-delta fiber endings. C-fiber nociceptors are reduced, according to histopathology studies. Both types of fibers contribute to posttraumatic hyperalgesia at the skin level, as studies show. Their deficiencies likely impact on posttraumatic hyperalgesia at the skin level and, probably, also at the skeletal level. CONCLUSION: It is hypothesised that deep dull aching in an acute diabetic Charcot foot may represent faulty posttraumatic hyperalgesia involving cutaneous and skeletal tissues. Co-Action Publishing 2013-05-21 /pmc/articles/PMC3661900/ /pubmed/23705057 http://dx.doi.org/10.3402/dfa.v4i0.20981 Text en © 2013 Ernst A. Chantelau and Tobias Wienemann http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Perspectives
Chantelau, Ernst A.
Wienemann, Tobias
Pressure pain perception in the diabetic Charcot foot: facts and hypotheses
title Pressure pain perception in the diabetic Charcot foot: facts and hypotheses
title_full Pressure pain perception in the diabetic Charcot foot: facts and hypotheses
title_fullStr Pressure pain perception in the diabetic Charcot foot: facts and hypotheses
title_full_unstemmed Pressure pain perception in the diabetic Charcot foot: facts and hypotheses
title_short Pressure pain perception in the diabetic Charcot foot: facts and hypotheses
title_sort pressure pain perception in the diabetic charcot foot: facts and hypotheses
topic Perspectives
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661900/
https://www.ncbi.nlm.nih.gov/pubmed/23705057
http://dx.doi.org/10.3402/dfa.v4i0.20981
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