A Comprehensive Guide to Diabetic Foot Problems:

Diabetic Neuropathy

Diabetes is a disease of the blood that affects your body’s ability to make or use insulin. Diabetes is a common and persistent problem for 1 in 10 adults.  The most common type of diabetes is Type 2 diabetes. This form of diabetes usually begins in adulthood and increases with age and weight gain. In addition, this form of diabetes often has no symptoms until complications develop such as nerve damage leading to amputations, blindness, kidney failure or heart disease. 40 to 60% of diabetic patients eventually develop diabetic neuropathy. When nerve damage and diabetic neuropathy strikes, it can be debilitating. You might experience tingling, numbness or pain in your feet or legs.

 

The risk of developing diabetic neuropathy increases with age and duration of type 1 or 2 diabetes mellitus as well as other health complications such as hypertension, hyperlipidemia, and obesity. The longer a patient has had diabetes – the greater their chance for developing symptoms of diabetic neuropathy. Unfortunately, many people are unaware they have it until there’s a serious injury to their foot.

 

Many people live with diabetic neuropathy for years, even decades without relief. The good news is that there are effective treatments available to help manage your symptoms and improve your quality of life.

What are the most common symptoms of diabetic neuropathy?

Symptoms of neuropathy may include; 

  • numbness
  • burning
  • tingling
  • pins and needles
  • weakness
  • Alterations in blood flow and sweating

Did you know that diabetes can cause your nerves to become more sensitive and respond differently? It might feel like a tingling sensation, pins-and-needles feeling or numbness. If it is not treated in time there may be damage done to the nerve endings which will lead to these symptoms getting worse as well as other issues such as blood flow problems and altered sweating patterns.

Sometimes people with diabetes may experience weakness as well because of their neuropathy issues. The body’s blood flow also changes due to these nerve problems leading to a lack of sweating that keeps us cool on hot days!

Nerve Damage of 3 different type levels can result in 'neuropathy:'

1. Sensory nerve damage

  1. Results in a gradual loss of feeling to the bottom of the feet
  2. Gradual onset with patients often unaware of how extensive it is
  3. Associated with
    1. burning
    2. tingling
    3. pins and needles
    4. coldness
    5. full feeling
  4. The tissue becomes less elastic and less flexible, localized circulation becomes diminished ‘a perfusion deficit’ there is less nutritive flow with the dissipation of electrolytes and toxic metabolites.

2. Autonomic nerve damage

  1. There is a gradual loss of control of the vessels, which results in decreased perspiration, creating dryness, scaling, and breaks in the skin.

3. Motor nerve damage

  1. A more severe case. A patient may notice changes with the fat pad under the “ball of the foot” moving forward, thereby making the bone heads more prominent and susceptible to increased pressures.
  2. The arches may become higher or lower with tightening of the heel cord and plantar fascia ligament.
    1. Susceptible to plantar fasciitis.
  3. The toes can contract and become crooked with bone prominences notable, these includes;
    1. hammertoes
    2. claw toes
    3. mallet toes
  4. Weakness or unsteadiness while walking.
  5. Walking/ gait abnormalities with abnormal biomechanics
    1. Can lead to foot deformities.
Peripheral neuropathy eventually affects 40-60% of diabetic patients and is a major contributing cause of lower-extremity amputation
  1.   Probability of patients with diabetes developing  neuropathy;
  • 20 % after 10 years*
  • 50 % after 20 years*
From the doctor: *The number of neuropathy patients may decrease as more patients strive for and achieve tight control of blood sugar glucose.

Brill, Leon R., et al. “Prevention of lower extremity amputation in patients with diabetes” Treatment of Chronic Wounds, no. 7, Oct. 1996, p. 2. Accessed 31 Dec. 2020. 

What is the cause of diabetic neuropathy?

The precise cause of diabetic neuropathy remains unclear, but both vascular and metabolic factors are at play. 

It coincides with both the duration and severity of hyperglycemia (persistent high blood sugar). The most critical injury is the loss of specific nerve fibers .

How do you diagnose diabetic neuropathy?

If you placed your hand on a burner, you would move it abruptly due to the pain. However, with neuropathy, painful stimuli are not recognized. 

 

Another testing for assessment of diabetic neuropathy includes vibration with a tuning fork 128 cycles at the level of the ankle and first metatarsal. Vibration perception threshold assessment with Biosthesiometer is also helpful in predicting those patients at high risk for ulceration.

Frykberg, Robert G., et al. Neurologic Procedures.” Diabetic Foot Disorders, Dec. 1999, pp. S17 (B, S17).

  1. Two ways to index the extent of the neuropathy:
    1. Ask patient whether they can sense stimuli going up and down the big toe
    2. Test the Patellar and Achilles reflexes 
  2. To differentiate between sharp and dull 
    1. Sharp and blunt touch via a pinprick test
    2. Dull contact via Cotton ball test

In rare cases, more sophisticated studies, such as nerve conduction studies, are necessary to diagnose peripheral sensory neuropathy.

Sensory and reflex loss varies from patient to patient; Most commonly

  1. Vibratory perception is the first to be lost
  2. Followed by Achilles reflex
  3. Finally, perception of pain in touch

Neuropathy is progressive. Patient’s awareness of diabetic neuropathy is key and medical care from a licensed podiatrist or doctor is of utmost importance to mitigate risks, injuries, and infections. 

 

Decrease feeling in the feet can lead to injuries and cuts that may go unnoticed. Such patients are particularly vulnerable to trauma while barefoot. Repetitive stress while wearing conventional footwear on both the feet’ tops and bottoms leads to injuries as well. 

How to prevent or delay diabetic neuropathy?

There are many steps available to delay or prevent diabetic neuropathy. The first step is to get blood sugar level under control. This includes:

  • Exercise
  • Replacing junk and foods that are high in sugar with fruits and vegetables
  • Keeping up with medications
  1. Use a blood glucose meter daily to monitor and change diet as necessary.
  2. Make sure your doctor tests your A1C test twice a year. This test will find your average of your blood sugar over the past 2 to 3 months.
  3. Notify your doctor or podiatrist if any new or more extensive sensations arise. 
  4. Regularly check your feet and limbs for signs of injury. Contact a doctor immediately if there are any signs.

When nerve damage and diabetic neuropathy strikes, it can be debilitating. You might experience tingling, numbness or pain in your feet or legs. Many people think they have to live with the discomfort caused by nerve damage and diabetic neuropathy because there is no known cure for these conditions.

That’s not true! Footsteps LLC provides a variety of treatment options to help patients find some relief from their symptoms so they can get back on their feet again. Our treatment programs combine state-of-the-art medical devices and expert podiatric care to provide comprehensive solutions for our clients’ problems. We do not offer a “one size fits all” approach; we customize our therapies based on each patient’s specific needs so they can achieve optimal results as quickly as possible while minimizing discomfort during the recovery process. You don’t have to suffer any longer! Call us today at (225) 756-0034  or fill out an online form

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