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A damaged diabetic foot

What is peripheral diabetic neuropathy?

Peripheral diabetic neuropathy is why foot pain is more dangerous for diabetics. 

Peripheral diabetic neuropathy is the most common type of nerve disorder caused by diabetes. It often causes pain, numbness, tingling, etc. in the toes, feet, legs, hands, and arms.

What causes peripheral diabetic neuropathy?

People with diabetes have high blood sugar content and, as a result, have lower blood oxygen content and thicker blood vessel walls. This means that circulation is slower and that less oxygen is being transported throughout the body. Pathogens can easily pile up in localized areas, ex. the foot, because the blood isn’t circulating them away and healing cuts/sores as quickly as possible. Additionally, an excess of sugar contributes to oxidative damage of vital organs, nerves, etc. Other possible causes include mechanical damage to nerves and blood vessels, autoimmune-related inflammation, lifestyle choices like smoking and drinking alcohol, and genetics.

Checking blood sugar

What are the symptoms of peripheral diabetic neuropathy?

Individuals with peripheral diabetic neuropathy don't always realize they have it at first. This is because nerve damage occurs over the course of many years and because it can cause numbness in the feet. If you can’t feel pain or sensation in your feet when you get a cut or blister, you’re more likely to get an infection and improperly care for the wound. Other symptoms may include…

  • Pain in toes, feet, legs, hands, and/or arms that can be described as burning, tingling, sharp, or stabbing.
  • Tingling, burning, or prickling sensations in toes, feet, legs, hands, and/or arms
  • Numbness or insensitivity to pain, temperature, or other stimuli
  • Atrophy/wasting away of muscles near affected nerves
  • Weakness, fatigue, muscle aches, cramps
  • Motor abnormalities when utilizing the affected extremity (stiffness, loss of balance/coordination, limping, loss of reflexes etc.)
  • Gastrointestinal indications (indigestion, nausea, vomiting, diarrhea, constipation, etc.)
  • Extreme sensitivity to non-painful stimuli, such as a light touch
  • Sudden changes in blood pressure upon standing/sitting, causing dizziness or faintness
  • Blisters/sores/cuts in the affected area that take an especially long time to heal or form ulcerations
  • Bacterial infections in the affected area (redness, swelling, warmth, tenderness, pain, etc.). In the feet these usually present as fungal toenails or athlete’s foot.
  • Foot deformities (hammertoes, collapsed arch, Diabetic Charcot Deformity, bunions, spurs, etc.)
  • Irritation of the skin and/or around the nails
  • Thick, dry, stiff, cracked skin and calluses

How is peripheral diabetic neuropathy treated?

A medical professional will likely conduct a physical exam to assess muscle strength, circulation, reflexes, sensitivity to pain and other stimuli, and skin/muscle/bone health. The first step after diagnosis will be to lower blood glucose levels to ensure that no further nerve damage occurs. Glucose monitoring techniques and diabetes medicines will be introduced if they haven’t been already, and you will be encouraged to engage in healthy meal planning and exercise to regulate your blood sugar. From there, different treatments will be utilized based on your specific symptoms.

  • Diabetic foot cream massages
  • Capsaicin cream, lidocaine patches
  • Nitrate sprays or patches
  • Conditioning foot cream, toenail oil
  • Foot roller exercises
  • Vitamin B supplements
  • Cushioned, supportive shoes and/or inserts
  • Physical therapy
  • Biofeedback
  • Acupuncture
  • Support hose/elastic stockings
  • Careful foot and skin care/maintenance
  • Antibacterial remedies for infections
  • Certain antidepressants and/or anticonvulsants (ex. duloxetine, bupropion, pregabalin, etc.)
  • Surgeries or therapies to improve circulation
  • In severe cases, surgerical amputation of the nerve-damaged limb may be necessary. This is a last resort to use if infection has spread into the bones.

How can peripheral diabetic neuropathy be prevented?

It is imperative that individuals with diabetes carefully inspect their extremities on a daily basis, especially their feet and toes. You should be looking for any blisters, cuts, swelling, redness, calluses, heat, etc. If you have trouble inspecting every part of your feet, you should enlist the help of a mirror or a friend willing to look over your feet for you. Any abnormalities, pain, and/or numbness should be reported to a medical professional as soon as possible. You should also consider doing the following…

  • Wash both of your feet with warm water every day to keep them clean and infection free. Try not to let your toes get pruney though; that’s an indication that you’ve soaked your feet for too long. Make sure to dry each foot and toe thoroughly afterwards.
  • Keep your feet moisturized; you can use regular lotion, special foot cream, diabetic foot cream lotion…anything to keep the skin on your feet soft and avoid cracking.
  • Give yourself regular pedicures: file corns and calluses away, trim your toenails, keep the cuticles well managed, etc. Be gentle with yourself, though; avoid doing anything to your feet that causes pain.
  • Wear comfortable, well-fitting shoes that leave room for your toes to move around. Try to wear shoes, slippers, or at least thick socks as often as possible to avoid potential injuries.
  • Use fitted orthotics, foot braces, orthopedic shoes, etc. as necessary.
  • Monitor your blood sugar levels to make sure glucose concentrations don’t get too high
  • Engage in regular exercise, especially non-impact activities like swimming, yoga, cycling, etc.
  • Fix all other foot related issues, such as bunions, hammertoes, corns, collapsed arches, etc. to avoid irritating or pressuring the feet too often
  • See a medical professional at least once every year for a physical examination and checkup.

Sources Cited:

http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diabetic-neuropathies-nerve-damage-diabetes/Pages/diabetic-neuropathies-nerve-damage.aspx

https://nfb.org//images/nfb/publications/vod/vodsum0403.htm

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