Peripheral Neuropathy Management

Foot Neuropathy

Neuropathy refers to loss of feeling in the feet. It can occur as a result of complications in people with diabetes. The most common form of neuropathy is peripheral neuropathy, which occurs when the nerves that run from the brain to the organs, muscles, skin and glands are impaired. This condition can cause an inability to feel heat, cold or even pain, therefore diabetics may not be able to feel any cuts or sores on the soles of their feet. If left untreated, these minor cuts and sores could get infected and result in ulceration which could lead to amputation. Therefore people with diabetes should perform a daily check of their feet to prevent any problems occurring. Neuropathy that is associated with other medical conditions or disorders requires similar advice regarding foot care.

Diabetic Peripheral Neuropathy

Diabetic neuropathy is nerve damage caused by diabetes. When it affects the arms, hands, legs and feet it is known as diabetic peripheral neuropathy. Diabetic peripheral neuropathy is different from peripheral arterial disease (poor circulation), which affects the blood vessels rather than the nerves.

Three different groups of nerves can be affected by diabetic neuropathy:
• Sensory nerves, which enable people to feel pain, temperature, and other sensations
• Motor nerves, which control the muscles and give them their strength and tone
• Autonomic nerves, which allow the body to perform certain involuntary functions, such as sweating.

Diabetic peripheral neuropathy doesn’t emerge overnight. Instead, it usually develops slowly and worsens over time. Some patients have this condition long before they are diagnosed with diabetes. Having diabetes for several years may increase the likelihood of having diabetic neuropathy.

The loss of sensation and other problems associated with nerve damage make a patient prone to developing skin ulcers (open sores) that can become infected and may not heal. This serious complication of diabetes can lead to loss of a foot, a leg, or even a life.

Causes
The nerve damage that characterizes diabetic peripheral neuropathy is more common in patients with poorly managed diabetes. However, even diabetic patients who have excellent blood sugar (glucose) control can develop diabetic neuropathy. There are several theories as to why this occurs, including the possibility that high blood glucose or constricted blood vessels produce damage to the nerves.

Symptoms
Depending on the type(s) of nerves involved, one or more symptoms may be present in diabetic peripheral neuropathy.

For sensory neuropathy:
• Numbness or tingling in the feet
• Pain or discomfort in the feet or legs, including prickly, sharp pain or burning feet

For motor neuropathy:
• Muscle weakness and loss of muscle tone in the feet and lower legs
• Loss of balance
• Changes in foot shape that can lead to areas of increased pressure

For autonomic neuropathy:
• Dry feet
• Cracked skin

Treatment
First and foremost, treatment of diabetic peripheral neuropathy centres on control of the patient’s blood sugar level. In addition, various options are used to treat the painful symptoms.

Medications are available to help relieve specific symptoms, such as tingling or burning. Sometimes a combination of different medications is used.

In some cases, the patient may also undergo physical therapy to help reduce balance problems or other symptoms.

At our clinic we see an increase of diabetic patents every year. Our goal is to help manage and educate our patients regarding foot care and relief from peripheral neuropathy symptoms. We use FREMS technology to help manage the symptoms of diabetic peripheral neuropathy.

Principles of Managing Neuropathy at Step By Step
The goals we are trying to achieve with pain free technologies are:

1) to retrain the nerves to function at normal thresholds, therefore requiring normal level of stimulation to function,

2) to repair damaged tissues by increasing circulation by revascularization, improving existing blood flow. Thus, more nutrients and most importantly oxygen reach the damaged tissue to improve healing.

3) The final step is to re-educate the nerves to communicate with surrounding tissue, therefore improving function and bringing balance back to life.