Nervous About Neuropathy? Diabetic Foot Neuropathy Explained

An Article Written by Cecilia Brennan
Podiatrist – New Step Podiatry

Podiatrists could write an endless amount of blog articles about neuropathy. Given earlier this month was National Diabetes Day, this article will focus on diabetes induced neuropathy that can occur in the feet.

This article will cover what nerves are, what is neuropathy, how diabetes causes neuropathy, what are the symptoms and signs of neuropathy and how best to manage the risks associated with neuropathy and the lower limbs.

What are nerves?

Nerves are the electrical cables and wires in our homes but for our bodies. They carry electrical impulses/messaging back and forth between the brain and the everywhere in your body. They help us to feel things and move. Can you think of some of the things we feel i.e. our senses? (Thinking time…. thinking time…. thinking time) Yep, that’s right! Nerves help us to feel touch, hot, cold but also pain, vibration, where we are (balance), taste different flavours, smell, hear and see.

Nerves also do background functions like controlling our sweating, digestion, breathing and managing our heart rate and blood pressure.

Here is a drawing of a nerve cell called a neurone.

What is neuropathy? What is peripheral neuropathy?

Did you know there is more than one type of neuropathy? Actually, there are heaps because the term ‘neuropathy’ just means nerve pathology. So many conditions of the nerves will fall under the term ‘neuropathy’.

Peripheral neuropathy is damage to the nerves outside of your brain and spinal cord. In the context of podiatry and diabetes related neuropathy, peripheral neuropathy is the damage to the nerves in your feet, ankle and legs.

How does diabetes damage nerves? How can I prevent damage to my nerves?

Being diagnosed with diabetes does NOT mean you will experience neuropathy. It’s long standing (years) and poorly managed blood sugar/glucose levels that damage peripheral nerves. We are not 100% sure how the excess blood glucose damages the nerve but theories have suggested it’s a restriction of blood flow or nutrients.

Prevention is key as nerve damage from diabetes can’t easily be reversed. It is very, very difficult for the body to ‘regrow’ nerves that have been damaged.

Managing your diabetes and blood glucose/sugar levels is a great way to prevent the nerve conditions. You can keep all the nerves in your body healthy by

– Avoiding smoking

– Enjoying a healthy and varied diet

– Limit your alcohol intake

– Stay hydrated with water

– Reduce stress

– Getting enough sleep/rest

– Exercising regularly

– Managing any other medical conditions that affect your nerves such as B12 deficiencies and drug induced neuropathy

It’s also best that it is assessed that diabetes is the cause of your neuropathy. There are plenty of other causes of neuropathy as you can see in this list.

 

What are the different types of diabetes related neuropathy in the feet and lower limbs?

Regarding diabetes related neuropathy and feet, we will focus on 3 peripheral neuropathies and how they can impact the feet.

Sensory: these nerves help us to feel things like pain, temperature and touch.

-If you can’t feel pain, you may not know that corn under your foot is super deep and causing inflammation.

-If you can’t feel heat, you may not know that your feet are too close to the heater.

-If you can’t feel light touch, you may not know there is a blister forming on your feet.

All these unnoticed skin traumas can cause deeper damage like ulcerations / wounds which if left too long and are unable to heal can mean amputation.
On top of this, damage to these nerves can cause all sorts of symptoms like numbness, burning, pain and pins and needles.

Motor: This is damage to the nerves that control muscles and movement in the body, such as moving your toes and ankles. You can have muscle loss which we call ‘atrophy’ and this can cause an imbalance between all the muscles in the feet resulting in toe shape changes such as claw toes. Claw toes can make shoe fit difficult and can cause focal areas of pressure for callus and corn development.

Autonomic: without us even thinking about it, autonomic nerves regulate our organs and glands including the sweat glands. Our natural skin lubricant, ‘sebum’ is released from sweat glands and when it isn’t getting released because of nerve damage, the skin can become dry and even cracked and broken creating a portal for bacteria or fungus to grow. That’s why us podiatrists often recommend moisturisers or urea-based creams.

These complications can put the feet at higher risk of developing bacterial and fungal infections, foot ulcers, and amputations. Podiatrists can help to reduce the risk of these complications, keep reading to find out some of our tips.

 

How do health professionals check for peripheral neuropathy in the lower limbs?

We ask, look, feel and assess.

 

First, we ask for symptoms of peripheral neuropathy such as numbness, burning, pins and needles, the feeling of insects clawing on your feet, poor balance and different types of pain.

Then we look, we are looking at the condition of your skin i.e. dry skin, the presence of ulcers and then we look at the structure of your feet i.e. claw toe and bony changes.

Then we feel, we feel your pulses, the range of motion of your joints, the strength and tone of your muscles.

Lastly, we assess using tools like monofilaments (pictured), tuning forks, reflex hammers, sharp/dull touch, heat/cold recognition. A neurologist may use a nerve conduction study.

How to manage the symptoms of peripheral neuropathy?

Are the pins and needles in your feet driving you nuts? Or perhaps you have pain associated with your nerve damage. Unfortunately, medicine has a long way to go to improve the symptoms and quality of life in those who suffer from neuropathy.

It’s best to discuss with your Podiatrist, General Practitioner, Pharmacist, Neurologist or Endocrinologist about what tablets or creams may be helpful.

For tablets/oral medications there are some antidepressants that may reduce nerve pain. There are other medications too but as with most medications there are potential adverse reactions that occurs, hence why it’s best to speak to your doctor to work out together if your symptoms are impacting you enough to trial these medications.

For creams and ointments, it can be a process of trialling a cream for a few weeks to see if symptoms reduce.

Other therapies like dry needling, acupuncture, Transcutaneous electrical nerve stimulation (TENS) machines, massage can work on some people but improvements may be short lived. Hopefully laser therapy to the affected area produces ongoing good results in medical research.

Lastly, prevention is key in diabetes related neuropathy. If you don’t currently have this nerve damage, please continue to manage your blood glucose levels and live a healthy lifestyle.

Tips to avoid the potentials consequences of peripheral neuropathy?

Here are some tips to prevent serious foot complications such as infections, ulcerations and amputations.

– Make sure your shoes fit well and are not too wide, narrow, long, or short.

– Avoid overly tight or irritating seams in socks and shoes.

– Check the insides of shoes and socks for any foreign objects.

– Moisturise feet daily to avoid cracks in the skin.

– Wash and dry the feet well.

– Do not attempt to self-treat an ingrown toenail or bump in the skin by cutting them.

– Keep the feet away from direct heat (e.g. heaters, hot water bottles, walking on hot cement barefoot) or check the temperature with your hand before use.

– Keep up daily exercise to help with circulation.

– See your podiatrist once every 6-12 months, or sooner if you need help with managing nails, skin, or a wound.

– Perform daily foot checks, using a mirror for hard to see areas.

What should I look out for when checking my feet?

– Broken or cracked skin (especially between toes and hard to reach areas)

– Hard areas of callus or corns

– Ingrown nails

– Blisters

– Sudden or unusual swelling and/or redness

– Unusual bumps or lumps on the feet

– Bruising or cuts

– Changes to the appearance of skin and nails

Apply first aid such as antiseptic and dressings to breaks in the skin. Attend a podiatrist, nurse or doctor to attend for areas of concern, in particular, if you are experiencing pain, if there are signs of infection, if there is a foreign body or a cut hasn’t healed in 2 weeks.
We are aiming to avoid ulcers and amputations like in this picture.

 

References

1 Alliance, L. S. (2014). How to do a 3-minute diabetic foot exam. The Journal of family PracTice, 63(11).

Pop-Busui, R., Boulton, A. J., Feldman, E. L., Bril, V., Freeman, R., Malik, R. A., … & Ziegler, D. (2017). Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes care, 40(1), 136-154.

https://9now.nine.com.au/a-current-affair/bert-newman-leg-amputation-aussie-famous-friends-supportive-messages/080d1b56-d7a0-4f87-9360-2ee203e545b4

Book an Appointment at Our Canberra Clinic for a diabetes foot assessment to check your nerves and circulation

Our podiatrists are here to ensure those in Canberra have access to quality services that can help individuals get the treatment they deserve. Easily book an appointment at our clinic online or give us a call on 02 6198 4818.