Posts for category: Diabetic Patients
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.
Diabetes is one of the most common metabolic diseases affecting Americans. The American Diabetes Association reports 23.6 million people in the US have Diabetes Mellitus which is 7.8% of the population. Common complications which can occur from diabetes include vision problems, kidney disease and loss of feeling in the hands and feet as well as wounds to the bottom of the feet.
Frequent medical visits with your podiatrist are imperative to the prevention of lower extremity complications related to diabetes. Foot deformities like hammertoes can form as a result of diabetes causing the patient to be at high-risk for the development of wounds to the feet. Untreated calluses or wounds to the feet often lead to infection, which frequently requires hospitalization and even amputation. Preventative measures taken by your podiatrist include the prescription of diabetic shoes and treatment of digital deformities, either with conservative treatment or surgical intervention. Dry skin can also create fissuring which can lead to infection. This also may be treated by a daily regimen as directed by your Podiatrist. Diabetic patients should perform a daily foot evaluation in their home to identify the development of ulcerations or calluses. The sooner a diabetic patient can receive medical attention for foot related issues, the better his or her chance is for a favorable treatment outcome.
Below are some statistics that should be very eye opening to any diabetic patient and stress the importance for both tight blood sugar control and frequent visits with their health care providers.
Patients with Diabetes Mellitus:
- Males are two times more likely to suffer heart attack
- Females are four times more likely to suffer heart attack
- Risk of stroke is doubled for both men and women
- 45% of diabetics will experience neuropathy (painful burning in the feet and loss of feeling)
- 15-20% will develop a lower extremity wound of which 15% will require amputation
- If you have a below the knee amputation there is a 40% chance of amputation to the other leg
- If you have a below the knee amputation, you have a 50% mortality rate in 5 yrs