A New and Noninvasive Antidromic Technique for Electrophysiological Evaluation of the Feet Digital Nerves

Document Type : Original Article (s)


1 Associate Professor, Neuromusculoskeletal Research Center AND Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

2 Physical Medicine and Rehabilitation Specialist, Neuromusculoskeletal Research Center AND Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

3 Associate Professor, Department of Physical Medicine and Rehabilitation, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran


Background: The purpose of this study was to introduce a new and noninvasive technique for antidromic electrophysiological evaluation of the feet digital nerves to find normal values of amplitudes and nerve conduction velocity (NCV).Methods: Ring electrodes were used to record sensory nerve action potentials from the digits one, two, and three of the foot. The E1 electrode was placed on the proximal phalanx, and the E2 electrode was located 1 cm distal to E1. The nerves were stimulated 10 cm proximal to the E1 electrode on the plantar surface. The 95% confidence intervals (CI) were used to report the normal values of the amplitudes, distal sensory latencies, and nerve conduction velocities.Findings: Twenty three healthy volunteers with a mean age of 47.3 ± 8.2 years were recruited in this study. The 95% CI of the sensory amplitudes were 5.2-7.5 μV, 6.0-8.9 μV, and 6.9-10.1 μV for the first, second, and third digits, respectively. There was an inverse relationship between the age and the amplitude (r = -0.48; P = 0.03). The relationship between body mass index (BMI) and amplitude was not significant (r = 0.23; P = 0.41).Conclusion: This new and noninvasive electrodiagnostic technique can be useful in early detection of distal neuropathy of the lower limbs; particularly when the routine electrodiagnostic studies may not be capable of diagnosing the subclinical neuropathy.


  1. Roman-Pintos LM, Villegas-Rivera G, Rodriguez-Carrizalez AD, Miranda-Diaz AG, Cardona-Munoz EG. Diabetic polyneuropathy in type 2 diabetes mellitus: Inflammation, oxidative stress, and mitochondrial function. J Diabetes Res 2016; 2016: 3425617.
  2. Kaku M, Vinik A, Simpson DM. Pathways in the diagnosis and management of diabetic polyneuropathy. Curr Diab Rep 2015; 15(6): 609.
  3. Zochodne DW. Clinical features of diabetic polyneuropathy. Handb Clin Neurol 2014; 126: 23-30.
  4. Sohn MW, Whittle J, Pezzin LE, Miao H, Dillingham TR. Electrodiagnostic consultation and identification of neuromuscular conditions in persons with diabetes. Muscle Nerve 2011; 43(6): 812-7.
  5. Khosrawi S, Haghighat S, Shayegannia E. Sensory and motor peripheral nerve findings in diabetic patients referred for electrodiagnosis. J Isfahan Med Sch 2011; 29(129): 165-71. [In Persian].
  6. Bae JS, Kim BJ. Subclinical diabetic neuropathy with normal conventional electrophysiological study. J Neurol 2007; 254(1): 53-9.
  7. Meidani M, Khorvash F, Rajabpournikfam MR. The relationship between controlling hba1c and infected diabetic foot ulcer. J Isfahan Med Sch 2012; 29(172): 26-31. [In Persian].
  8. Chatzikosma G, Pafili K, Demetriou M, Vadikolias K, Maltezos E, Papanas N. Evaluation of sural nerve automated nerve conduction study in the diagnosis of peripheral neuropathy in patients with type 2 diabetes mellitus. Arch Med Sci 2016; 12(2): 390-3.
  9. Park KS, Lee SH, Lee KW, Oh SJ. Interdigital nerve conduction study of the foot for an early detection of diabetic sensory polyneuropathy. Clin Neurophysiol 2003; 114(5): 894-7.
  10. Oh SJ, Kim HS, Ahmad BK. Electrophysiological diagnosis of interdigital neuropathy of the foot. Muscle Nerve 1984; 7(3): 218-25.
  11. Dumitru D, Amato A, Zwarts M. Electrodiagnostic Medicine. 2nd ed. Philadelphia, PA: Hanley and Belfus; 2001.
  12. Uludag B, Tataroglu C, Bademkiran F, Uludag IF, Ertekin C. Sensory nerve conduction in branches of common interdigital nerves: A new technique for normal controls and patients with Morton's neuroma. J Clin Neurophysiol 2010; 27(3): 219-23.
  13. Falck B, Hurme M, Hakkarainen S, Aarnio P. Sensory conduction velocity of plantar digital nerves in Morton's metatarsalgia. Neurology 1984; 34(5): 698-701.
  14. Squintani G, Zoppini G, Donato F, Pineschi E, Donini D, Stoico V, et al. Antidromic sensory nerve conduction study of the digital branches of the medial plantar nerve: A novel method to detect early diabetic sensory axonal polyneuropathy. Muscle Nerve 2014; 50(2): 193-9.
  15. Hemmi S, Inoue K, Murakami T, Sunada Y. Comparison of the sensitivities of plantar nerve conduction techniques for early detection of diabetic sensory polyneuropathy. Electromyogr Clin Neurophysiol 2010; 50(6): 269-75.