Peripheral Neuropathy is a nerve condition that affects the arms, hands, legs, and feet. The most common form of peripheral neuropathy is due to diabetes.
Diabetic Peripheral Neuropathy
People with diabetes have an abnormal elevation of their blood sugar, and lack adequate insulin to metabolize the blood sugar. As a consequence, the blood glucose (sugar) abnormally enters certain nerve tissue and damages the nerve. This can occur in any type of diabetes. It does not matter if the patient is on insulin, is taking pills, or is diet controlled. The nerve damage that occurs is considered to be permanent.
As the nerve damage occurs, the protective sensations are affected. These include a person’s ability to determine the difference between sharp and dull, hot and cold, pressure differences, and vibration. These senses become dulled and/or altered. The process begins as a burning sensation in the toes and progresses up the foot in a "stocking distribution". As the condition progresses, the feet become more and more numb. Some people will feel as though a pair of socks on their feet, when in fact they do not. Other patients will describe the feeling of walking on cotton, or a water-filled cushion. Some patients complain their feet burn at night, making it difficult to sleep. The feet may also feel like they are cold, however, to the touch they have normal skin temperature. Diabetic peripheral neuropathy is not reversible. The progression of the condition can be slowed or halted by maintaining normal blood glucose levels.
As the patient develops diabetic neuropathy, they have a greater risk of developing skin ulcerations and infections. Areas of corns and callouses on the feet represent areas of excessive friction or pressure. These areas, if not properly cared for by a foot specialist, will often break down and cause ulcerations. Ulcerations and infection can form under the calloused area. These calloused areas may not be painful. As a result, they can progress to ulceration without being noticed. Ingrown toenails can progress to severe infections in people with neuropathy. Simple things like trimming the toenails present a risk to these patients because they may accidentally cut the skin and not feel it. People with neuropathy must be very cautious and inspect their feet daily. They should not soak their feet in hot water or use heating pads to warm their feet. This can result in accidental burns to the skin. Barefoot walking should be avoided because of the risk of stepping on something sharp and not being aware of it. The inside of the shoes should be inspected before putting the shoes on to insure that no foreign object is inside the shoe.
Our office is equipped with a machine called the Doppler. This exam measures the vascular blood flow in the foot and ankle through a non-invasive procedure. Like a sonogram, a gel is spread over the ankle and foot, and the doctor can assess the blood flow by computer readout. The test is quick, easy, and accurate.
Alcoholic Peripheral Neuropathy
Alcoholic neuropathy is caused by the prolonged use of alcoholic beverages. Ethanol, the alcoholic component of these beverages, is toxic to nerve tissue. Over time, the nerves in the feet and hands can become damaged resulting in the same loss of sensation as that seen in diabetic neuropathy. The damage to these nerves is permanent. A person with this condition is at the same risk, and should take the same precautions as people with diabetic peripheral neuropathy. Peripheral neuropathy can also be caused by exposure to toxins such as pesticides and heavy metals.
Treatment For Peripheral Neuropathy
Patients diagnosed with diabetes mellitus should also consider having specially made shoes to protect their feet. Most patients with diabetes qualify for footwear and inserts under the Medicare Therapeutic Shoe Bill. Medicare covers patients for one pair of shoes and three inserts per year. Our office has partnered with Orthofeet shoes which offer a proper fitting for the diabetic patient with extra width across the midfoot and ample room at the toe-box to avoid pressure. These shoes are also designed to accommodate orthotics.