My name is David Northcutt. I’m oneof the podiatrists here at Dallas Podiatry Works. Today I want to discuss diabetic peripheralneuropathy. There are several reasons for the development of peripheral neuropathy,but diabetic peripheral neuropathy is one of the most common. Diabetic peripheral neuropathy simply meansnerve damage that is caused from having diabetes. This is not something that develops rapidly,but is a slowly worsening and progressive condition which happens over the period ofseveral years. The loss of sensation that occurs with nerve damage from diabetes makesthe patient more prone to developing open
sores or ulcers. Patients often do not know that they havea sore or wound, due to this lack of sensation. This can lead to significant complicationsincluding amputations. Diabetic peripheral neuropathy usually occurs in patients whodo not maintain their blood sugar well, however it can occur in anyone with diabetes. The symptoms of neuropathy include numbness,tingling, pain, burning in the feet which can progress up to the legs, there’s oftenloss of muscle tone, loss of balance, and changes to foot structure. To determine whetheryou have diabetic peripheral neuropathy, a
history and physical will be performed. Simple,in office, noninvasive testing helps to diagnose the problem. Neurologic tests sometimes areordered. Sometimes a biopsy of the peripheral nerves in the skin may also be performed.Treatment of diabetic peripheral neuropathy begins with good control of your blood sugar.There are oral medications as well as topical medications that may reduce your symptoms.Prevention of diabetic peripheral neuropathy includes maintaining good blood sugar levels. If you have any symptoms of numbness, burning,tingling in your feet or legs, please give us a call at Dallas Podiatry Works. We willwork to get the correct diagnosis to help
relieve your symptoms..
Causes of Neuropathic Pain
Neuropathic pain differs from other typesof pains and in order to start talking about neuropathic pain, it’s important to rememberwhat pain actually is. So, nociceptive pain or pain that we sense usually is nerves transmittingan impulse and letting us know that there is a damage or injury to part of our body.Neuropathic pain is an actual pathology of the nerve itself. Nerve consists of its body,which is the axon, which is the part that usually gets injured and when that axon isinjured what happens is abnormal transmission of impulses. It’s important to remember thatit’s not nerves communicating an injury elsewhere, but the process in the nerves themselves.Neuropathic pain itself presents differently
from other types of pain. So, neuropathicpain is likely to be severe. It is usually sharp. It is electric shocklike sensationthat people usually describe. It is lightning or lancinating type of pain that most peopletalk about when they describe neuropathic type of pain. Accompanying that, it can bea deep burning or, at the same time, it can also present as coldness in the limbs or distributionof that nerve. It also comes, at times, with persistent numbness, tingling, or weaknessof the muscles that nerve supplies. Neuropathic pain usually travels along thepath of the nerve itself. Because the nerves have different function some nerves aremotor nerves, some nerves are sensory nerves
if the sensory part of the nerve is affected,it can alter sensation. Now, it can actually decrease sensation in other words, createnumbness or it can heighten sensation where normal stimuli are now painful or altered so something that would usually be a normal muscle sensation, such as light touch, canbecome a painful sensation. There are many causes for neuropathy or neuropathicpain affecting the nerves. Some of those are compression of the nerve. Now, compressionof the nerve can occur anywhere along the path of the nerve. It can be as it exits thespine and travels onward, as in radiculopathy or in other words, pain arising from compressionof the spinal nerve before it exits the spinal
column or it can be peripheral nerve compression.And many of us know what it feels like when we cross our legs and the leg goes numb thatis compression of the peripheral nerve and usually that recovers by itself, but if thatcompression remains for a longer period of time, then that can become not necessarilypermanent, but the recovery from that can take months and sometimes even a whole year.Other sources of the neuropathy can be systemic processes, such as diabetes. Diabetes is amicrovascular process decreasing the supply of nutrients to tissues as well as nervesand that tends to be what’s called a quot;lengthdependant process,quot; in other words, nerves that arelonger tend to be affected first and that’s
why people with diabetic neuropathy tend tofeel their feet being affected first because the nerves are that much longer, so thosenerves tend to be affected first, then the hands follow that because they are the nextlongest nerves in the body. That being said, any process that can damagetissue can also damage nerve tissue. So, what I mean is treatments like chemotherapy thereare different chemotherapy agents that can alter different processes that the nervesdepend on and some are actually neurotoxic in other words, they are damaging the nervesdirectly. Now, chemotherapy affecting the nerves can appear at the time of the treatment,but it can also be a delayed presentation
of that neuropathy. Also, radiation; a processthat radiation causes, in the long run, can come up as postradiation fibrosis. In otherwords, tissues fibrose and contract and can affect the nerves and that can cause neuropathyas well..