Peripheral neuropathy is caused by damage to the nerves, resulting in the loss of feeling and temperature sensation.
The reason for numbness in the feet (peripheral neuropathy) in people with diabetes is still largely unknown. It is believed to be associated with high blood sugar levels and unstable diabetes affecting the nerve sheath fibers and message impulses. The longer you have had diabetes the greater risk of peripheral neuropathy.
Causes of Peripheral Neuropathy:
- Medical conditions – diabetes, alcoholism, Spina Bifida
- Hereditary conditions – Charcot Marie Tooth, Lupus
- Metabolic conditions – thyroid dysfunction, kidney and liver failure
- Infections – HIV, Syphilis, Leprosy, Gullain-Barre, Lyme Borreliosis
- Malnutrition – vitamin B12, B6, niacin and folate deficiency
- Physical conditions – trauma or injury to nerves, Sciatica
- Drugs and medication – cytotoxic drugs (chemotherapy)
- Exposure to toxins or heavy metal contamination – lead or mercury
Signs and Symptoms of Peripheral Neuropathy:
- Numbness and tingling in the feet.
- Sharp shooting pain.
- Feeling of swollen feet.
- Sensation of wearing socks or stockings when not.
- Burning or freezing sensation.
- Dry skin and lack of sweating.
- Bounding foot pulses, yet cold toes.
- Muscle weakness in legs.
- Loss of normal sensation (unable to detect trauma).
- Hyper-sensitivity to touch (painful).
- Symptoms are often more severe at night.
Risk Factors of Peripheral Neuropathy:
- Foot ulcerations and burns – due to being unable to detect trauma/injury to feet.
- Infections- if unaware trauma has occurs and wound left untreated.
- Increased risk of falls – due to changes in leg muscles, proprioception and foot structure, altering the walking style.
Assessment for Peripheral Neuropathy:
An annual diabetes assessment by a podiatrist is essential in determining any sensation loss and the risks of undetected foot injury. The podiatrist will use a 10g monofilament and vibration tuning fork to assess the protective sensation and balance in your feet.
Management of Peripheral Neuropathy:
There is not official treatment for peripheral neuropathy, as the nerve damage is irreversible. However there are several ways to manage the symptoms including:
- Good blood sugar level control.
- Reduce consumption of caffeine, cigarettes and alcohol – these often increase symptoms.
- Undertake regular, moderate exercise.
- Massage feet gently to improve circulation.
- Apply cool tap water for 10-15 minutes or cooling gel before going to bed.
May be prescribe to improve symptoms of peripheral neuropathy. The medications often have unwanted side effects. These should be discussed with your GP.
- Topical capsaicin cream (0.075%) – applied to affected area 3-4 times/day. Symptoms may get worse before relief is achieved.
- Mechanical tapping – may be applied by podiatrist.
- Socks – wear 2 pairs of well fitted socks to bed. Ensure there is no elastic at top of sock, which could reduce circulation.
- Compressive stockings (high percentage Lycra) – only if blood flow has been assessed by medical practitioner or podiatrist.
Some patients may experience painful peripheral neuropathy (PPN), as a result of their diabetes or other factors mentioned above. It is important to speak to your podiatrist at Well Heeled Podiatry about the treatment modalities that are available.WARNING: This information should be used as a guide only and does not replace professional podiatry advice. The content is provided by Well Heeled Podiatry for educational purposes only and does not in any way replace the need for a face to face consultation with a podiatrist in order to accurately diagnose and treat the condition. Treatment and outcomes will vary between patients depending on the nature of the presenting complaint and subsequent diagnosis of condition.