Shimomura K, Taketa T, Uchiyama Y, Kodama N, Domen K. Bilateral Foot Drop Caused by Acute-onset Neuropathy after Diabetic Ketoacidosis: Successful Management and Long-term Follow-up for Employment.
Prog Rehabil Med 2024;
9:20240028. [PMID:
39263412 PMCID:
PMC11384146 DOI:
10.2490/prm.20240028]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 08/27/2024] [Indexed: 09/13/2024] Open
Abstract
Background
Peripheral neuropathy is a common complication of diabetes, impacting many patients with type 1 or 2 diabetes. Acute-onset peripheral neuropathy after diabetic ketoacidosis (DKA) is rare yet serious, and reports on long-term functional outcomes and rehabilitation for this condition are limited. We present a case of bilateral foot drop caused by acute-onset peripheral neuropathy following DKA. The case was effectively managed through prompt and continuous intervention.
Case
A 21-year-old male university student with no notable medical history who was seeking employment presented with impaired consciousness. DKA associated with type 1 diabetes was diagnosed. As blood glucose and acidosis improved, he rapidly regained consciousness. On Day 3 post-onset, bilateral foot drop and lower leg sensory impairment emerged, with nerve conduction studies indicating lower extremity peripheral neuropathy on Day 8. Improvement during hospitalization was modest, so ankle-foot orthoses were prescribed on Day 10. He could walk independently with the orthoses on Day 12 and was discharged home on Day 15. Outpatient follow-up was continued to support the patient's efforts to gain employment. Needle electromyography in the tibialis anterior muscles bilaterally showed denervation at 2 months and polyphasic potentials at 8 months. In the 2 years post-onset, bilateral lower limb muscle strength progressively improved, and the patient successfully secured clerical employment.
Discussion
Successful rehabilitation for employment was achieved in the rare condition of acute-onset neuropathy after DKA through effective management based on early orthotic prescription, clinical and electrophysiological examinations, and continuous follow-up.
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