By: Neil Scheffler
Q: I’ve been told that I have diabetic neuropathy. What is that and what can I do about it?
A: Diabetic neuropathy is a disorder of the nerves that is a common complication of diabetes. The symptoms of neuropathy include numbness or a decrease in sensation in the feet and/or legs, pins and needles sensations, severe burning, stabbing or shooting pains, less perspiration and possible changes in the shape of the feet.
As you can see, the symptoms can vary from person to person. In general, however, I like to help my patients with neuropathy understand it better by dividing them into two classes-those with painful neuropathy and those whose feet are numb (to confuse matters even more, some patients have a combination of the two).
Those with neuropathy that produces hyper-sensitive feet can have symptoms that range from very mild discomfort to excruciating pain that stops them from sleeping at night or being able to work. My first step with these patients is to make sure that, in fact, the problem is with the nerves. Sometimes a decrease in blood circulation can create similar symptoms.
Once I’m sure that the problem is diabetic neuropathy, I try the simplest, safest treatments first; some patients respond to vitamin B-6 or B-12. There is also a topical cream made from capsaicin, a chemical that comes from hot peppers, that, when applied three or four times daily, often relieves the pain. If these trials don’t work I then consider the use of oral medications such as antidepressants, which seem to relieve the pain in some patients. Finally, there are surgical procedures that can be performed to relieve pressure on the nerves that supply the foot.
The kind of neuropathy that causes the foot to become numb presents an entirely different set of problems. At first glance one might say “So what if my feet are numb? I don’t care. It doesn’t hurt.” This attitude can be disastrous!
Pain often protects us. Step on a piece of glass or on hot sand at the beach and you jump. If you can’t feel the pain then you could walk on a tack in your shoe all day long. That happens to many people with diabetic neuropathy.
Continued walking on an area with a callus or blister can cause the skin to breakdown causing an ulcer that may become infected and lead to gangrene and even amputation. Since pain is not felt, repeated trauma can even cause small fractures or dislocations of bones causing the foot to change shape (Charcot Joint).
Prevention is the key. First of all, according to the findings of the DCCT (Diabetes Control & Complications Trial) tight control of your diabetes can help prevent neuropathy. If you do have a decrease in sensation you must take extra precautions.
Examine your feet daily-on top, bottom and between the toes. If you can’t see well, use a mirror or enlist a family member to help. If any changes are noticed call your foot doctor immediately.
Never walk without a foot covering, even at the beach. Never use any over-the-counter medications on your feet without asking your podiatrist first. Some medications look harmless but can create lots of trouble for people with diabetes. Watch out for hot water in the tub. Check the temperature with your hand or a thermometer before entering.
Finally, see your podiatrist regularly. This foot specialist will advise you on proper shoes and may prescribe special shoe inserts. Medicare may even help to pay for those shoes and inserts.