Foot problems are not only the most common but in general also the most severe of the diabetic complications. The age group 15-50 yrs in this study was chosen because these patients were considered to be at their most active age and were felt to require optimal foot function. 380 patients (96 %) participated, 78 % with Type 1, 20 % Type 2 and 1 % with secondary diabetes mellitus (DM) and 100 healthy controls. Only six patients had signs of peripheral ischaemia but half of the patients had deformities such as fallen forefoot arches and hammer toes. With sensory thresholds and clinical signs it was demonstrated that age, duration of DM and tall stature are major risk factors for diabetic neuropathy. Gender differences depend on differences in height. Dorsiflexion of the toes against resistance was used to test the function and volume of m.extensor digitorum brevis. When compared with measurements of sensory thresholds for vibration, perception and pain, it was found to be a valuable test for screening of distal motor neuropathy. To prevent worsening of foot deformities 266 patients with Type 1 DM were followed for 3 years. Those with the most pronounced deformities were fitted with custom-made insoles and had repeated examinations. Improvement was more common in patients with insoles compared to patients without insoles. Bone mineral density (BMD) was measured in nine patients with osteopathy in their feet and 18 controls. BMD was lower in L2-L3, but not in the proximal femur, implying osteopenia being a possible risk factor for distal osteopathy. Plaster cast treatment was used in 33 diabetic patients with severe foot ulcers who were selected because previous conservative treatment had been unsuccessful and they had been judged unsuitable for vascular surgery. The lesions healed in 19 patients. In conclusion, the main findings demonstrate the need for an increased awareness of early preventive foot care in young and middle-aged diabetic patients. / <p>S. 1-46: sammanfattning, s. 47-120: 6 uppsatser</p> / digitalisering@umu

För att undersöka misstänkt tillklämningsneuropati i peroneus communis (PC) används elektroneurografi, där elektrisk stimulering möjliggör undersökning av nervledningshastigheter, svarsamplitud och överledningstid. Vid opålitlig registrering på extensor digitorium brevis (EDB), görs registreringen på tibialis anterior (TA). I dagsläget finns dock inga normalvärden eller standardiserad metod för registrering på TA. Syftet med studien var därför att ta fram dessa normalvärden och utveckla en metod för TA-registrering, och samtidigt jämföra de båda registreringspunkterna gällande nervledningshastighet, undersöka sidoskillnaderna vid registrering på TA och undersöka hur kroppslängden påverkade överledningstiden. Det undersöktes om s.k. F-waves kunde påvisas vid registrering på TA och i så fall hur hög svarsandelen och svarslatensen var. 22 deltagare mellan 23-59 år gamla och 154-190 cm i kroppslängd undersöktes. TA undersöktes med den aktiva registreringselektroden på muskeln där den var som störst och med referenselektroden på fotleden. Stimuleringar gjordes på laterala poplitea fossa och 110 mm ned distalt om caput fibula. EDB undersöktes enligt metodbeskrivning. Normalvärdena för TA var 2,2-5,4 mV gällande amplitud, 55-73 m/s gällande nervledningshastighet och 3,8-5,9 ms gällande överledningstid. Sidoskillnaderna var 0-1,4 mV gällande amplitud, 0-8 m/s gällande hastighet och 0-0,8 ms gällande överledningstid. De beräknade gränsvärdena visar på de små sidoskillnaderna som krävs för en klinisk betydelse. Överledningstiden kunde till 23 % förklaras av kroppslängden. Resultaten var likvärdiga med tidigare studier. Jämförelsen av nervledningshastigheten mellan registrering på TA och EDB visade en statistiskt, men inte nödvändigtvis kliniskt signifikant skillnad, med bias + 5 m/s. F-waves återfanns hos samtliga deltagare, med svarsandelen 94-100 %. F-wave svarslatensen kunde till 41 % förklaras av kroppslängden. / Electroneurography is used to examine a suspected entrapmentneuropathy in peroneus communis (PC), where an electric stimulus enables the evaluation of nerve conduction velocity, muscle response amplitude and latency. If registration from the extensor digitorum brevis (EDB) provides unreliable results, the registration can be made from tibialis anterior (TA). Currently there are no normal values available in our laboratory and no standard method regarding the registration on TA. The purpose of this study was therefore to retrieve normal values for this registration and to develop and establish a method, and also compare the different registration sites, to examine the side differences from the registrations on TA, and how the height affected the latency. It was also examined if so called F-waves could be recorded from TA, and if so, determine the response rate and latency. 22 participants between 23-59 years an 154-190 cm were examined. TA was examined with the active registration electrode on the site where the muscle was the largest and the reference electrode on the ankle. Stimulations were made on lateral poplitea fossa and 110 mm lower on distal caput fibula. EDB were examined according to established methods. Normal values for the registration on TA were 2,2-5,4 mV regarding amplitude, 55-73 m/s regarding nerve conduction velocity and 3,8-5,9 ms regarding latency. Side differences were 0-1,4 mV regarding amplitude, 0-8 m/s regarding nerve conduction velocity and 0-0,8 ms regarding latency. The calculated limits show that it only takes small side differences to have a clinical significance. The method gave equivalent results to previous studies. 23 % of the latency could be explained by height. The comparing of the nerve conduction velocity from the different registrations showed a significant statistical, but not necessarily clinical, difference, with the bias 5 m/s. F-waves were retrieved from all participants with a response rate of 94-100 %. 41 % of the F-wave latency could be explained by height.