Your Feet: Diabetic Neuropathy

It is well known that foot problems are among the most frequent complications of diabetes. One of the primary reasons that people with diabetes have foot problems is because of a disorder known as diabetic neuropathy.

Diabetic neuropathy causes the nerves to malfunction. When nerves malfunction, major complications can occur in the feet. There are two major types of this neuropathy: Painful and non-painful. Paula Yutzy, R.N., a diabetes educator that I work with at Harbor Hospital Center in Baltimore, describes the two types to her patients as the “screaming type” and the “silent type.” Both are problematic.

The “screaming,” or painful, neuropathy may begin with mild symptoms of pins and needles or mild burning. In the more painful stages, the symptoms may be described as sharp, shooting, stabbing, or severe burning. The pain can prevent sleep at night. In severe cases those afflicted have trouble wearing shoes.

One treatment for this neuropathy can include a medication made from hot peppers. This medication, a cream called Zostrix, contains capsaicin, which appears to deplete substance P from nerves. Without this substance the nerves cannot transmit the sensation of pain due to the neuropathy to the brain. I was fortunate to be one of the researchers studying this drug and found that a majority of my patients benefited from its use. If you have this type of neuropathy ask your podiatrist (foot specialist) about this hot pepper cream which is applied to the skin three to four times daily. Other oral medications may also be prescribed.

The other type of neuropathy, the “silent” type, although not painful, can be even more dangerous to those who have it. With this disorder the body doesn’t feel pain. A patient can walk in a shoe with a nail sticking up on the inside and not feel it. Splinters of wood or glass can also go unnoticed and an infection can result. This is one reason those with diabetes should never walk with bare feet.

Corns and calluses are usually minor problems. They often cause discomfort and are easily treated, Those people with diabetic neuropathy, however, may continue to walk on these areas without noticing the pain. Someone without neuropathy would stop walking, perhaps take off or change shoes, and fix the problem. Those without the protective pain sensation continue to walk on the area which often progresses to ulceration and infection. Many hospitalizations for foot ulcers and infections are due to diabetic neuropathy.

Since even minor cuts, scrapes, or blisters can progress to major disasters that could even lead to amputation it is important to examine your feet daily. If you can’t see your feet, have a relative or friend do it for you. Any changes from day to day can then be noticed and your podiatrist can be notified. The earlier that problems such as these are treated, the better.

Repeated stress on a foot that doesn’t feel pain can lead to a foot deformity called Charcot Foot, If you notice that your foot is abnormally swollen, hot, or deformed, call this to the attention of your foot doctor immediately. Infections can have a similar appearance.

It is now clear that many complications of diabetes can be prevented or delayed. The Diabetes Control and Complications Trial (DCCT) showed that as much as 60% of nerve damage can be prevented with tight control. If you are not in tight control, perhaps the concern about neuropathy, which, by the way, affects more than just your feet, will be the impetus to see your diabetes doctor and ask what you can do together to achieve tight control.

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