Spend some time in a podiatry clinic and you will see and hear it all. Recently, a diabetic patient being treated for an aliment of his right foot stated, “I think there is something in my left shoe.” I expected to find a fold in his sock, a pebble but no… he took off his shoe and removed a six inch black comb! We looked at each other with mutual surprise and he said, “I’ve was wondering where that went…I’ve been looking for it all day!” This just illustrates that diabetics with neuropathy can never be too careful when it comes to their feet.
Diabetes is a metabolic disorder characterized by the bodies inability to process glucose (sugar) leading to elevated levels circulating throughout the body. Diabetes Mellitus can be categorized into two types: Type 1 (Lack of Insulin) and Type 2 (Inability to respond to insulin). Type 1 is typically diagnosed early in life before elevated sugars can cause damage to your body. Type 2 on the other hand is not typically diagnosed until later in life, meaning elevated sugar levels have had 10-15 years to damage the eyes, the heart, the blood vessels and the nerves.
Neuropathy refers to damage of the body’s nerves. This can occur in a number of different ways but diabetes is a very common cause. It typically starts out affecting the peripheral nerves of the hands and feet and is described as a “glove and stocking” distribution. Later on the nerves of the heart, GI tract and bladder can occur. People suffering from neuropathy describe altered sensations of the hands and feet such as burning, tingling, numbness or even shooting pain.
Diagnosis can be made with the combination of a thorough history and examination along with simple blood work looking at sugar levels along with the body’s levels of vitamins B12 and B9. If examination and lab work indicate diabetes and/or neuropathy, studies such as an EMG (electromyogram) or NCV nerve conduction velocity) or epidermal nerve fiber testing can help determine the severity of progression.
Not much can be done to “cure” neuropathy due to long standings diabetes. Vitamin B12 and Folic Acid levels can be checked and if low supplements can help reverse the symptoms. In the majority of cases treatment is aimed at managing diabetes and controlling sugar levels. Calming the nerve related symptoms of burning and tingling can be achieved with prescription medications like Metformin, Lyrica, Cymbalta or topical compound creams. Physical therapy with VST or anodyne treatments has also proven helpful in decreasing symptoms. In some cases, patient may be a candidate for nerve decompression surgery.
The importance of proper management is in the prevention of complications like ulcerations, infections and amputations. Like the patient mentioned above, neuropathy causes decreased feeling in the hands and feet. This means patients do not feel rubbing or foreign objects in the shoes, which can lead to open sores and wounds and/or infection. So, if you or someone you know is suffering from the signs and symptoms of diabetes and/or neuropathy, call North Texas Foot & Ankle at (214) 574-9255 to schedule a consultation.
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