Improving vibration perception in a patient with type 2 diabetes and sensory peripheral neuropathy

Introduction:  Diabetes mellitus (DM) and its related sensory peripheral neuropathy (SPN) are the biggest risk factors for foot ulcer formation and lower limb amputation. Reduced vibration perception results in less sensitivity to pressure and is a known risk factor for diabetic foot ulcers. Improving vibration perception in the feet of people with SPN could be protective against foot ulcers. The aim of this study was to determine if a therapeutic vibrating insole, used for 35 consecutive days, could improve vibration perception in a patient with type 2 DM. Patient presentation:  The patient was a 63 year-old male with a medical history of peripheral vascular disease, controlled hypertension, hyperlipidaemia, artherosclerosis and SPN secondary to controlled type 2 diabetes. Management and outcome:  The patient used the insoles for 20 min a day for 35 consecutive days. Vibration perception thresholds were measured four times in total: once at baseline, immediately post intervention, 1 month and 10 months later. Vibration perception threshold decreased with an average of 22 V (range 6 V–34 V) dependant on the tested location and time after intervention. The improvement remained after 1 and 10 months. Conclusion:  The use of a vibrating insole as a therapeutic device improved this patient’s perception of vibration in his feet. Clinically, vibrating insoles potentially might reduce the risk for ulcer formation and subsequent lower limb amputation in patients with DM and SPN. Clinical implications:  Using a vibrating insole therapeutically, can potentially improve the perception of vibration and pressure in patients with sensory peripheral neuropathy secondary to type 2 diabetes mellitus. Improved vibration perception might reduce the risk for diabetic ulcer formation and subsequent lower limb amputation.