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Diabetic Neuropathy

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Description

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 of 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.

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

Treatment for peripheral neuropathy is, for the most part, directed at the symptoms of the condition. Vitamin B12 injections may be helpful if the patient has a vitamin B deficiency. There are certain oral medications that may ease the burning pain that can be prescribed by your doctor. Topical ointments should only be used with the advice of your doctor. Magnetic therapy and Galvanic Stimulation are alternative forms of treatment but results are varied and difficult to quantify.

Description

This is a question and answer that we felt was worth sharing.

Question:
I am age 67 and have been a diabetic since the age of 50. Insulin dependent for the last 5 yrs. My feet often have hard callouses on them which I have had trimmed by a podiatrist. Unfortunately, this has led to severe infection and have lost my bid toe because of this. At the moment I am again battling an infection. I am wondering what is the alternative to trimming a callous. I understand Vitamin C is good for healing. Do you have any info on this? I would be greatful for any advice you could give me.

Answer:
Callous build up on the foot is due to abnormal pressure and friction as you stand and walk. It is important that the callous not get to thick or the skin under the callous can break down and cause an ulceration. It is not uncommon for me, when treating a diabetic patient with callouses on the feet, to trim a callous and find an ulcer under the callous. If the callous is not trimmed, then the infection can progress into the bone or deep into the foot. Good nutrition and vitamin supplements will help with healing but the most important issue is adequate blood flow. If you have bad circulation ask your doctor about hyperbaric oxygen treatment.

You should also discuss with your doctor about obtaining a diabetic shoe and molded insole to protect your foot.

Description

Dry scaling skin on the feet is most commonly due to chronic athlete's foot. This is caused by a fungal infection of the skin and is often associated with a fungal infection of the toenails. Frequently, the skin has a dull, reddish appearance in a "moccasin" like distribution on the bottom of the foot.

Psoriasis also causes dry scaling of the skin. It presents as small, white flaky patches. When these scales are scrapped off it will cause pinpoint bleeding. Psoriasis can also present as pustules or small blisters.

Neurodermatitis often presents as a solitary patch of dry, scaling skin that itches constantly. Commonly, it occurs on the ankle. Its cause is unknown. Treatment consists of using topical steroid creams or ointments. Injecting the area with cortisone will also often cure the condition. Allergic dermatitis and contact dermatitis also cause skin rashes but tend to be more acute.

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