By Dr. Elizabeth Vulanich
November 26, 2012
Category: Diabetic Patients
Tags: Diabetes   Foot Pain   Neuropathy   Numbness   Tingling  

My doctor says I have neuropathy - what is “neuropathy?” "Neuro" refers to nerve and “–pathy “ refers to disease. On the simplest level, neuropathy is a “disease of nerves”. Neuropathy may be caused by numerous conditions which cause injury to the nerves outside of your central nervous system. Neuropathy may involve nerves to your muscle(s) or to the nerves which permit you to feel sensations such as hot/cold and sharp/dull sensations.

In your podiatrist’s office, we are often referring to the most common neuropathy, a small fiber neuropathy, which is associated with diabetes. This is typically a “peripheral polyneuropathy” or an “outside of the central nervous system-many nerve-disease”. It most commonly involves the feet and legs, beginning in the toes, and progressing towards the knees. It may less commonly involve the hands. This is the reason that the condition is often referred to as having a stocking/glove pattern of altered sensation. A patient may complain of a burning kind of pain or even sharp, sudden stabbing pain, or numbness. Symptoms are often worse at night. Many times a patient will say that their feet feel very cold yet when they actually touch them, they are warm. It is probably easiest to think of neuropathy as a condition in which your nerves are unable to correctly inform you of what they are sensing. 

A patient with diabetes should develop the habit of looking at their feet every day. Feet with neuropathy need to be inspected DAILY to ensure that the skin is intact and that no new lumps, bumps, color changes, temperature changes, swelling or bruising has occurred. The diabetic patient should use their eyes and hands to assess their feet for changes. Use a non-breakable mirror if necessary. Learning to know their “normal” feet will better permit identification of a potential problem. Remember, these affected feet cannot accurately tell their owners what they are sensing. It is possible for numbness to be so profound so as to be able to walk on broken glass or scald the skin without feeling pain!

Until fairly recently, diagnosis of small fiber neuropathy was a clinical diagnosis and one of exclusion. Your podiatrist typically will perform certain tests including vibration and monofilament testing and may order nerve conduction studies and electromyelographic  studies to help determine the source of the nerve pain. In the case of small fiber neuropathy, these tests will be normal.  If this occurs, a more recent test, a skin biopsy, may be performed. In the case of small fiber disease, this test will identify a reduction or absence of small nerve fibers and be able to indicate an abnormal appearance of the nerves.

Treatment for neuropathy is dependent upon identifying the cause. It often is a chronic condition and, in the case of diabetes, is best treated by early detection and tight control of elevated blood sugars. The painful symptoms are treated with oral medications as well as topical compounds.

If you believe you may be experiencing the painful symptoms of peripheral neuropathy or if your feet feel numb, contact your podiatrist or healthcare professional for further evaluation and treatment.

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