Peripheral Neuropathy Effect on Ankle Inversion and Eversion Detection Thresholds

A servo-controlled foot platform was used to quantify, in upright stance, the thresholds for sensing ankle inversion and eversion movements in seven geriatric patients with peripheral neuropathy (PN) confirmed by nerve conduction studies and seven age- and gender-matched (C) controls with normal nerve conduction function. The PN group had a 4.6-fold larger (p = 0.0026) threshold (mean [SD] 1.37 [1.74]degrees) for perceiving the presence and direction of an ankle rotation at a 75% rate of success (TH75) than did the C group (0.3[0.17]degrees). Inversion acuity was approximately twice that of eversion acuity in both groups. The PN group demonstrated better proprioceptive acuity in unipedal stance than in bipedal stance, whereas no such difference was found in the C group. Semiquantitative clinical tests of PN group proprioception at the ankle performed in the seated position failed to demonstrate significant differences from controls save in one case; however, the results of such tests at the toe were abnormal in all patients. In the geriatric population, PN is associated with deficits in ankle proprioception known theoretically to hamper maintenance of unipedal balance. It is significant that these deficits are associated with a clinically demonstrable loss of position sense at the toe but not the ankle.