Bilateral Foot Drop Caused by Acute-onset Neuropathy after Diabetic Ketoacidosis: Successful Management and Long-term Follow-up for Employment

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.

Keywords: neuropathy; orthoses; outcome prediction.

Fig. 1.

Clinical course during hospitalization and outpatient follow-up. The patient was admitted to the ICU on Day 1 because of impaired consciousness resulting from diabetic ketoacidosis and was discharged to the general ward on Day 2. Bilateral foot drop was noted on Day 3, and voluntary contraction of the tibialis anterior muscles was not observed bilaterally during hospitalization. NCS was conducted on Day 8. Posterior ankle–foot orthoses were prescribed on Day 10. Following discharge from the hospital on Day 15, follow-up was conducted in the outpatient setting, and gradual improvement was observed clinically over time. The muscle strength of ankle dorsiflexion improved to grade 5 (MMT) bilaterally 2 years after onset.