Diabetic neuropathy is a complication of diabetes that results in damage to the nervous system. It is a progressive disease, and symptoms tend to worsen over time. Nerves are essential to how the body functions; they control sensation, movement, and automated functions like breathing and heartbeat. Once nerves are damaged, the control signals are reduced or lost.
Damage can affect virtually any nerve in the body, with a wide range of symptoms depending on the nerves affected. Elevated blood sugar levels over long periods in a diabetic patient eventually cause the development of nerve damage throughout the body.
Early nerve damage may not have any obvious signs or symptoms. As the damage worsens, a diabetic person may experience loss of tactile sensation, burning pain or tingling in the feet and hands. Because sensation has diminished in a diabetic patient, any injury sustained (i.e. a cut on the foot, development of a blister, an inflamed ingrown toenail, etc.) may not be noticed in time. A wound which is left untreated can fester and develop an infection that can spread quickly. This can lead to extensive tissue death (gangrene), leaving diabetic patients to fight for their life or face amputation of the affected limb.
Four main types of neuropathy can impact on the nervous system, including:
- Peripheral symmetric neuropathy: This affects the feet first, and then the hands. It is the most common form of diabetic neuropathy.
- Autonomic neuropathy: This occurs in the nerves that control involuntary functions of the body such as digestion, urination, or heart rate.
- Thoracic and lumbar root, or proximal, neuropathy: This damages nerves along a specific distribution in the body, such as the chest wall or legs.
- Mononeuropathies: These can affect any single individual nerve.
Podiatry encounters and often treats peripheral neuropathy and mononeuropathies in diabetic patients.
Symptoms of diabetic neuropathy build up over time, and commonly affect the feet and lower legs first:
- Numbness in the feet and hands in the distribution of a sock or glove
- Abnormal or altered sensation in hands or feet
- Constant pain in the extremities
- Tendency to lose balance; difficulty walking without wobbling
- Loss of muscle tone in the hands and feet
- Inability to feel temperature differences by touch, or physical injury to the limb
- Tingling or burning sensations radiating from the toes to the ankles (then up the legs over time)
- Bone deformity or collapse in the feet (Charcot arthropathy/ diabetic foot deformity)
Diabetic neuropathy worsens with time, regardless of the maintenance of sugar and fat control. This is a secondary effect of diabetes and will cause patients greater problems with co-morbidities, as it affects their daily bodily functions. Even without the development of abnormal pains, patients will be at risk for falls if they do not address the early signs of diabetic neuropathy.
What can podiatry do to help my diabetic neuropathy?
- Carry out comprehensive foot examinations and diabetic foot-specific tests to ensure sensation and blood flow to the feet are not declining rapidly.
- Regular routine foot care to ensure the feet are maintained without risk of infection or neglected wounds, and that intact skin barrier and nails are preserved without issue.
- Help patients to remain active and mobile using aids and devices inside and outside their footwear.
- Preserve the shape and function of the feet as much as possible as diabetic feet deform and collapse over time.
- In-clinic treatment to reduce the tingling, numbness and burning sensation.
- In-clinic treatment to reduce muscle tightness and increase localised blood supply.
- Specialised wound care when wounds develop, and prevention of wound recurrence once healed.
- Reduce patient’s likelihood of falls risk with gait training and in shoe modifications.
- In cases of severe neuropathy, podiatry can design and fit customised ankle foot orthotics to ensure the patient is mobile with less risk of falling.
- A prevention and wellness treatment ethos to help the patient avoid limb amputation as much as possible.
- Appropriate referral for surgical opinion, if required.
Proactive prevention is always better than reactive treatment, when it comes to the diabetic foot. At-risk diabetic patients should be seen every 3 to 6 months to ensure that the foot status is maintained. Low-risk diabetic patients should be seen yearly if there are no major concerns with the integrity of the foot and lower limb.