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What is Diabetic Peripheral Neuropathy?
Diabetic neuropathy is nerve damage caused by diabetes. The type of
neuropathy occurring in the arms, hands, legs and feet 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.
Signs and Symptoms
Depending on the type(s) of nerves involved, one or more signs and symptoms may
be present in diabetic peripheral neuropathy.
For sensory neuropathy:
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Numbness or tingling in the feet
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Pain or discomfort in the feet or
legs—including prickly, sharp pain or burning feet
For motor neuropathy:
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Muscle weakness and loss of muscle
tone in the feet and lower legs
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Loss of balance
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Changes in foot shape that can lead
to areas of increased pressure
For autonomic neuropathy:
What Causes Diabetic Peripheral Neuropathy?
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.
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Motor Neuropathy (Deformity) |
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Ill-fitting Shoes |
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Sensory Neuropathy (Numbness) |
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Ulcers (Sores) |
As diabetic
peripheral neuropathy progresses, various nerves are affected—and these damaged
nerves can cause problems that encourage development of ulcers. For example:>
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Deformities (such as bunions
or hammertoes) resulting from motor neuropathy may
cause shoes to rub against toes, creating a sore. The numbness caused by sensory
neuropathy can make the patient unaware that this is happening.
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Because of numbness, a patient may
not realize that he or she has stepped on a small object and cut the skin.
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Cracked skin caused by autonomic
neuropathy, combined with sensory neuropathy’s numbness and problems associated
with motor neuropathy can lead to developing a sore.
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 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:
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Keep blood sugar levels under
control.
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Wear well-fitting shoes to avoid
getting sores.
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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.
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Visit your foot and ankle surgeon on
a regular basis for an examination to help prevent the foot complications of
diabetes.
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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.
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