Geometrical Interruption in the Nerve Anatomical Model of the Foot to Simulate Small Fiber Neuropathy

Diabetic Foot Ulceration (DFU) is a type of Small Fiber Neuropathy (SFN) which usually arises in the unmyelinated smaller Intra-Epidermal Nerve Fibers (IENF) of the foot. Skin biopsy is a diagnostic method to examine quantitatively IENF in the foot but examination is limited to the specific positions of the body. Computational models may provide an alternative approach to examine SFN. Formerly, an anatomical model of Normal IENF (NIENF), based on IENF Density (IENFD) at various locations in the human foot was presented. Therefore, in this study, a geometrically Interrupted IENF (IIENF) model is developed using reduced IENFD, to simulate SFN at miscellaneous locations of the human foot. This IIENF model was then compared with the NIENF model for the same location of the foot and observed reduced IENF network in this IIENF model as compared to NIENF model. Furthermore, approximately 98% of the realistic IENF terminals at the skin were generated using the modified Monte Carlo Algorithm (MCA) and the reduced empirical IENFD at the various locations of the foot. This IIENF model provides a starting platform for evaluating diabetic foot ulceration. The IIENF model may be used in future studies for functional consequences by stimulating the most distal sensory IENF of the skin of the foot.