Neuropathy

NERVE DAMAGE

Nerve damage leads to loss of sensation in the feet, and they become particularly vulnerable to wounds and infection, often leading to amputation. Diabetic peripheral neuropathy is a long-term complication of diabetes. Exposure to high blood glucose levels over an extended period of time causes damage to the peripheral nerves – the nerves that go to the arms, hands, legs, and feet.

Symptoms of diabetic peripheral neuropathy

Although diabetic peripheral neuropathy can occur in many places in the body, the most common symptoms are abnormal sensations in the toes and feet, including:

  • Sharp, shooting pains
  • Burning
  • Tingling
  • A feeling of being pricked with pins
  • Throbbing
  • Numbness (not able to properly feel pain, heat, or cold)

Diabetic peripheral neuropathy increases the risk for foot ulcers and amputation. Due to nerve damage in their feet and toes, people with diabetes who have diabetic peripheral neuropathy often do not notice minor cuts, sores, or blisters in these areas. If left untreated, these small wounds can easily become infected, lead to gangrene, and may eventually require amputation of the affected area.

Risk factors for diabetic peripheral neuropathy

Risk factors for diabetic peripheral neuropathy include:

  • High blood glucose (sugar) levels
  • Elevated triglycerides
  • Excess body weight
  • Smoking
  • High blood pressure

Diagnosing diabetic peripheral neuropathy in the feet

Your doctor or foot care specialist can test for diabetic peripheral neuropathy by lightly pressing a thin nylon rod (10-gram monofilament) to different areas of your foot (in particular, your big toe) or by using the 128-Hz tuning fork on the back of the big toe to determine if you can feel it. These are easy and pain-free tests.

When to screen for diabetic peripheral neuropathy

  • For type 1 diabetes
    • Because diabetic peripheral neuropathy is uncommon within the first five years after onset of type 1 diabetes, annual screening for diabetic peripheral neuropathy should begin after five years of diabetes diagnosis.
    • For children with type 1 diabetes, screening should be done once the child is past puberty and has had diabetes for at least five years.
  • For type 2 diabetes
    • For people with type 2 diabetes, screening for diabetic peripheral neuropathy should begin right away, at diagnosis of diabetes, and every year after that.

How can I prevent complications of diabetic peripheral neuropathy?

Although there is no cure, there are many ways you can effectively manage diabetic peripheral neuropathy.

Foot Care

  • Proper foot care
  • Examine your feet using a mirror if necessary.
  • Care for your nails regularly and clip toenails straight across.
  • Apply lotion if your feet are dry (but not between the toes).
  • Wear properly fitting footwear.
  • Test your bath water before you step in to make sure it’s not too hot.
  • Do not soak your feet.
  • Let your doctor examine your feet at each visit
  • Don’t walk barefoot
  • Take any wounds, cuts and sores to your doctor.

Foot Ulcers

Ulcers occur most often on the ball of the foot or on the bottom of the big toe. Ulcers on the sides of the foot are usually due to poorly fitting shoes. Remember, even though some ulcers do not hurt, every ulcer should be seen by your health care provider right away. Neglecting ulcers can result in infections, which in turn can lead to loss of a limb. What your health care provider will do varies with your ulcer. Your health care provider may take x-rays of your foot to make sure the bone is not infected. The health care provider may clean out any dead and infected tissue. You may need to go into the hospital for this. Also, the health care provider may culture the wound to find out what type of infection you have, and which antibiotic will work best.

Keeping off your feet is very important. Walking on an ulcer can make it get larger and force the infection deeper into your foot. Your health care provider may put a special shoe, brace, or cast on your foot to protect it. If your ulcer is not healing and your circulation is poor, your health care provider may need to refer you to a vascular surgeon. Good diabetes control is important. High blood glucose levels make it hard to fight infection. After the foot ulcer heals, treat your foot carefully. Scar tissue under the healed wound will break down easily. You may need to wear special shoes after the ulcer is healed to protect this area and to prevent the ulcer from returning.

Poor Circulation

Poor circulation (blood flow) can make your foot less able to fight infection and to heal. Diabetes causes blood vessels of the foot and leg to narrow and harden. You can control some of the things that cause poor blood flow. Don't smoke; smoking makes arteries harden faster. Also, follow your health care provider's advice for keeping your blood pressure and cholesterol under control. If your feet are cold, you may be tempted to warm them. Unfortunately, if your feet cannot feel heat, it is easy for you to burn them with hot water, hot water bottles, or heating pads. The best way to help cold feet is to wear warm socks.

Some people feel pain in their calves when walking fast, up a hill, or on a hard surface. This condition is called intermittent claudication. Stopping to rest for a few moments should end the pain. If you have these symptoms, you must stop smoking. Work with your health care provider to get started on a walking program. Some people can be helped with medication to improve circulation. Exercise is good for poor circulation. It stimulates blood flow in the legs and feet. Walk in sturdy, good-fitting, comfortable shoes, but don't walk when you have open sores.

Amputation

People with diabetes are far more likely to have a foot or leg amputated than other people. The problem? Many people with diabetes have peripheral arterial disease (PAD), which reduces blood flow to the feet. Also, many people with diabetes have nerve disease, which reduces sensation. Together, these problems make it easy to get ulcers and infections that may lead to amputation. Most amputations are preventable with regular care and proper footwear.

For these reasons, take good care of your feet and see your health care provider right away about foot problems. Always follow your health care provider's advice when caring for ulcers or other foot problems. One of the biggest threats to your feet is smoking. Smoking affects small blood vessels. It can cause decreased blood flow to the feet and make wounds heal slowly. A lot of people with diabetes who need amputations are smokers.

Excellent blood glucose control

Managing your blood glucose levels effectively can help to prevent further nerve damage.

Medications

Some medications that act on the nerves, can be helpful.
*See a podiatrist every six months if possible.