Peripheral Neuropathy: Diabetic
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- Posterior Tibial Tendon Dysfunction (PTTD)
- Accessory Navicular Syndrome
- Common Disorders of the Achilles Tendon
- Achilles Tendon Rupture
- Diabetic Complications and Amputation Prevention
- Ankle Arthritis
- Ankle Fractures
- Chronic Ankle Instability
- Ankle Pain
- Ankle Sprain
- Arch Pain
- Arch Supports
- Athlete's Foot
- Baseball Injuries to the Foot and Ankle
- Basketball Injuries to the Foot and Ankle
- Soft Tissue Biopsy
- Black Toenails
- Bone Healing
- Bone Infection
- Bone Tumors in the Foot
- Brachymetararsia
- Bunions (Hallux Abducto Valgus)
- Bursitis
- Calcaneal Apophysitis (Sever's Disease)
- Fractures of the Calcaneus (Heel Bone Fractures)
- Calf Pain
- Callus
- Capsulitis of the Second Toe
- Cavus Foot (High-Arched Foot)
- Charcot Foot
- Clubfoot
- Cold Feet
- Compartment Syndrome
- Contact Dermatitis
- Corns
- Cracked Heels
- Crutch Use
- Custom Orthotic Devices
- Cyst-Ganglion
- Deep Vein Thrombosis (DVT)
- Dermatitis
- Diabetic Complications and Amputation Prevention
- Diabetic Foot Care Guidelines
- Diabetic Peripheral Neuropathy
- Diabetic Shoes
- Drop Foot
- Dry Heels
- DVT (Deep Vein Thrombosis)
- Eczema of the Foot
- Equinus
- Extra Bones
- Fallen Arches
- Field Hockey Injuries to the Foot and Ankle
- Fifth Metatarsal Fracture
- Flatfoot-Adult Acquired
- Flatfoot-Flexible
- Flatfoot-Pediatric
- Flexible Flatfoot
- Foot Arthritis
- Foot Bumps
- Foot Drop
- Foot Fracture
- Foot Lumps
- Foot Odor
- Foot Rash
- Football Injuries to the Foot and Ankle
- Fracture-Ankle
- Fracture-Foot
- Fractures of the Calcaneus (Heel Bone Fractures)
- Fractures of the Fifth Metatarsal
- Fracture-Toe
- Frostbite
- Fungal Nails
- Ganglion Cyst
- Gangrene
- Golf Injuries to the Foot and Ankle
- Gout
- Haglund's Deformity
- Hallux Rigidus
- Hammertoes
- Heel Bone Fractures
- Heel Cracks
- Heel Fissures
- Heel Pain (Plantar Fasciitis)
- High-Arched Foot
- Inflammation: Actue
- Ingrown Toenails
- Instructions for Using Crutches
- Intermetatarsal Neuroma
- Intoeing
- Joint Pain in the Foot
- Joint Swelling in the Foot
- Jones Fracture
- Lacrosse Injuries to the Foot and Ankle
- Lisfranc Injuries
- Lumps
- Malignant Melanoma of the Foot
- MRSA Infection of the Foot
- Orthotics
- Os Trigonum Syndrome
- Osteoporosis
- Osteoarthritis of the Foot and Ankle
- Osteomyelitis (Bone Infection)
- Osteopenia
- P.A.D. (Peripheral Arterial Disease)
- Pediatric Flatfoot
- Peripheral Arterial Disease (P.A.D.)
- Peripheral Neuropathy: Diabetic
- Peroneal Tendon Injuries
- Pigeon-toes
- Plantar Fasciitis
- Plantar Fibroma
- Plantar Wart (Verruca Plantaris)
- Posterior Tibial Tendon Dysfunction (PTTD)
- Pump Bump (Hallux Rigidus)
- Puncture Wounds
- Rash
- Raynauds Phenomenon
- Restless Legs
- Rheumatoid Arthritis in the Foot and Ankle
- R.I.C.E Protocol
- Rugby Injuries to the Foot and Ankle
- Running and Track Injuries to the Foot and Ankle
- Running Injuries
- Sesamoid Injuries in the Foot
- Shin Splints
- Shoe Inserts
- Skin Cancer of the Foot and Ankle
- Smelly Feet
- Soccer Injuries to the Foot and Ankle
- Soft Tissue Biopsy
- Softball Injuries to the Foot and Ankle
- Sports Injuries to the Foot and Ankle
- Staph Infections of the Foot
- Stress Fracture in the Foot
- Sweaty Feet
- Swollen Ankles
- Swollen Feet
- Synovitis
- Tailor's Bunion
- Talar Dome Lesion
- Tarsal Coalition
- Tarsal Tunnel Syndrome
- Tennis Injuries to the Foot and Ankle
- Thick Toenails
- Tingly Feet
- Tired Feet
- Toe and Metatarsal Fractures (Broken Toes)
- Toe Walking
- Turf Toe
- Ulcers/Wounds
- Varicose Veins
- Volleyball Injuries to the Foot and Ankle
- Warts
- Weak Ankles
- Webbed Toes
- White Toenails
- Wounds/Ulcers
- Wounds-Puncture
- Yellow Toenails
What is Diabetic Peripheral Neuropathy?
Diabetic neuropathy is nerve damage caused by diabetes. When it affects the arms, hands, legs and feet it is known as diabetic peripheral neuropathy. Diabetic peripheral neuropathy is different from peripheral arterial disease (poor circulation), which affects the blood vessels rather than the nerves.
Three different groups of nerves can be affected by diabetic neuropathy:
- Sensory nerves, which enable people to feel pain, temperature, and other sensations
- Motor nerves, which control the muscles and give them their strength and tone
- Autonomic nerves, which allow the body to perform certain involuntary functions, such as sweating.
Diabetic peripheral neuropathy doesn’t emerge overnight. Instead, it usually develops slowly and worsens over time. Some patients have this condition long before they are diagnosed with diabetes. Having diabetes for several years may increase the likelihood of having diabetic neuropathy.
The loss of sensation and other problems associated with nerve damage make a patient prone to developing skin ulcers (open sores) that can become infected and may not heal. This serious complication of diabetes can lead to loss of a foot, a leg, or even a life.
Causes
The nerve damage that characterizes diabetic peripheral neuropathy is more common in patients with poorly managed diabetes. However, even diabetic patients who have excellent blood sugar (glucose) control can develop diabetic neuropathy. There are several theories as to why this occurs, including the possibilities that high blood glucose or constricted blood vessels produce damage to the nerves.
As diabetic peripheral neuropathy progresses, various nerves are affected. These damaged nerves can cause problems that encourage development of ulcers. For example:
-
Motor Neuropathy (Deformity)
+
Ill-fitting shoes
Sensory Neuropathy (numbness)
Ulcers (sores)
- Because of numbness, a patient may not realize that he or she has stepped on a small object and cut the skin.
- Cracked skin caused by autonomic neuropathy, combined with sensory neuropathy’s numbness and problems associated with motor neuropathy can lead to developing a sore.
Symptoms
Depending on the type(s) of nerves involved, one or more symptoms may be present in diabetic peripheral neuropathy.
For sensory neuropathy:
- Numbness or tingling in the feet
- Pain or discomfort in the feet or legs, including prickly, sharp pain or burning feet
For motor neuropathy:
- Muscle weakness and loss of muscle tone in the feet and lower legs
- Loss of balance
- Changes in foot shape that can lead to areas of increased pressure
For autonomic neuropathy:
- Dry feet
- Cracked skin
Diagnosis
To diagnose diabetic peripheral neuropathy, the foot and ankle surgeon will obtain the patient’s history of symptoms and will perform simple in-office tests on the feet and legs. This evaluation may include assessment of the patient’s reflexes, ability to feel light touch, and ability to feel vibration. In some cases, additional neurologic tests may be ordered.
Treatment
First and foremost, treatment of diabetic peripheral neuropathy centers on control of the patient’s blood sugar level. In addition, various options are used to treat the painful symptoms.
Medications are available to help relieve specific symptoms, such as tingling or burning. Sometimes a combination of different medications is used.
In some cases, the patient may also undergo physical therapy to help reduce balance problems or other symptoms.
Prevention
The patient plays a vital role in minimizing the risk of developing diabetic peripheral neuropathy and in preventing its possible consequences. Some important preventive measures include:
- Keep blood sugar levels under control.
- Wear well-fitting shoes to avoid getting sores.
- Inspect your feet every day. If you notice any cuts, redness, blisters, or swelling, see your foot and ankle surgeon right away. This can prevent problems from becoming worse.
- Visit your foot and ankle surgeon on a regular basis for an examination to help prevent the foot complications of diabetes.
- Have periodic visits with your primary care physician or endocrinologist. The foot and ankle surgeon works together with these and other providers to prevent and treat complications from diabetes.