skin punch
 

Why is peripheral neuropathy skin punch biopsy taken from the calf instead of the foot?

Primarily--
 

--because the original normed figures that intraepidermal nerve fiber density ranges were based on (the original work was done at Johns Hopkins) came from groups of subjects in which the density was measured at lower leg, upper thigh, and right above the elbow.

The original Johns Hopkins researchers chose these places as they are standard places of hairy skin with at least a thin fat layer, meaning it was easy to take the samples and there were few structures to get in the way or compromise the measurements.

It is possible to take samples from anyplace there is hairy skin--I know a few people who've even had it done on the face--but it's much harder to interpret the results in these areas as normative levels of nerve fiber density are not well known.

thanks glenntaj
 

But what if my neuro only took a biopsy from both calves and not the ankle or upper leg.

It can still be normed and compared--
 

--with known values from "normal" patients at that location.

Still, more comprehensive testing would involve the other sites as well--and doing the biopsy at multiple sites might also show whether any reductions in intraepidermal nerve fiber density were dependent on the length of the nerves, which can have some diagnostic value in some cases.

I also suspect they don't do the foot, because injuries/wounds on feet don't heal well. Many PNers have diabetes, and part of their monitoring is to avoid injuries to the feet!

biopsy results
 

Rec'd my biopsy results. Test results say "Density of epidermal nerve fibers in normative range."
However, I had "degenerative changes within epidermal nerves." "These findings are often predictive of the future development of clinical neuropathy"
"Mild Morphologic degenerative changes are seen among intra-epidermal nerve fibers."
"Epidermal nerves are mildly patchy in distribution.Occasional epidermal nerves are varicose in appearance."
It goes on and on about the microscopic description.
I failed "Tinel's Sign" diagnosis and EMG studies were inconclusive.
(I failed one foot and passed the other)
Neuro thinks Tarsal Tunnel and favors injections or MRI next.
What do you guys think?

What parts did you have biopsied?
 

And, were there comparisons among nerves from different parts, if they were done?

Looks to me like you might have caught the neuropathy developing or at an early stage, in which there are degenerative changes but not enough of those to put your intraepidermal nerve fiber density outside of the statistical norms as of yet.

Biopsy was only taken from each calf location.

IF it were me? I'd go the MRI and ...
 

even cat scan route before trying the tarsal tunnel injections. Does this neuro do tarsal surgeries? IF so? Be veerry cautious. Few here have had long term success from such procedures. Altho short term relief can be found with injections. Nothing is long term nor a cure.
I wish I could be more optimistic? But, following a regime of Vitamins B-1, B-12, calcium w/magnesium and D can help off set a good deal of damages many encounter here. Do take a look at all the Mrs D has to say, please. She is one who suffers from PN but has been able to manage it far better than most and knows all about the supplements one needs to help your body heal and get better. Doesn't work overnite? But, it does help a great deal!
Hugs and hope truly :hug::hug::hug:! - j

I'm going to see a neuro at Vanderbilt next week. Ill check into the mri
Many thanks

Good place, and good choice?
 

Be cautious about anyone wanting to do 'surgeries' for PN.
Nerve conduction testing and blood work, plus spinal fluid analyses are key to determining potential sources for neuropathies... Do go to the 'stickies' at the top and wade thru the various sources for testing... The best are:
http://neuromuscular.wustl.edu/alfindex.htm - this, go to the peripheral neuropathy aspects and see how many there are...it's mind boggleing! then check out
http://neurotalk.psychcentral.com/thread135993.html
Are starters, but there are other goodies in the 'stickies' to read and learn from.
I don't know about you? But when docs start mumbling about the 'snorficscamium' and 'vasculinifisortium' you are already overloaded and, I for one, just 'nod' OK.... I instead, now ask them to write what's going on down [in a way I can REALLY read it?] so I can learn more about it on my own. I find I'll either get respect or disdain for that asking. Docs who are disdainful? Well, gee, they mite just feel threatened by knowledge from the AAFP, The NIH or the like? Sad, but true on more than one occasion. It can be a 'dance' of minds.. so always if you must? cite impeccable sources such as the ones I've mentioned above.
Please don't agree tho? To a full sural nerve biopsy without an outside second opinion! Punch biopsies? OK, but not the full nerve extraction. I'd declined and I'm glad I did? Tho now? As an absolute last resort for proof of diagnosis would I agree to it. The LAST RESORT...and many insurance co's no longer cover it as a diagnostic procedure due to potential complications of the surgery. This is NOT to scare you? Merely to let you learn and know where you mite stand and how far you are willing to go for a diagnosis at this time or a later time.
Persue testings, but at a measured and prudent time frame and course of direction. I hope you get a good or advantageous diagnosis! It took me less than a year, but it was one heck of a time! I sure hope yours is easier and faster. If you've any questions, don't be shy about asking. We've lots of good people here and a lot of differing opinions. Do take into consideration tho? That we've all gotten here by different routes.
Hope and faith in a good diagnosis and result! :hug::hug::hug:!'s - j