Neuropathy

When blood flow is restricted to the small blood vessels that feed nerve cells, those nerve cells are damaged and die, we call this Neuropathy.

This damage can occur in any area of the body controlled by nerve function. The most common is certainly peripheral neuropathy as those nerves most distal are supplied by the smallest and most vulnerable blood vessels, but neuropathy can also impact the autonomic nervous system impairing regulation of temperature and blood  pressure. It can impact vascular nerves impairing the ability to regulate blood pressure, heart rate and rhythm, as well as the urinary system leading to incontinence or incomplete voiding.

The GI tract leading to severe digestive issues.

And decreased blood flow to the genitals can lead to sexual dysfunction.

 

Below is a list of complications which can arise from neuropathy.

Amputation Dysrythmia Dysautonomia Incontinence Gastroparesis Hearing loss ED/Sexual dysfunction

Neuropathy is often initially observed in the most peripheral areas of the body like our hands and feet.

This is called peripheral neuropathy. This diabetes complication is estimated to effect 30-50% of people with diabetes.

Neuropathy impact ranges from discomfort to excruciating pain and and eventually loss of sensation. This can be disabling in a world where touch screens and fine motor skills with one’s hands are crucial to daily functioning! You’ve probably experienced how clumsy it feels to try to operate a phone or keyboard when your fingers are numb with cold or have “fallen asleep” now imagine that feeling being permanent!

In feet this numbness leaves patients at higher risk for foot injury--without feeling it! It is not uncommon for people with neuropathy to have foot wounds that become infected which then go on to become a life threatening risk, because they could not feel the initial injury. 

I can not tell you how many times I have seen people survive cancer only to be taken out by a blister on their toe that progressed to ostemylitis. I once did an initial home assessment with a patient and as he walked across the room it sounded as if he was tapping. Upon assessment I discovered a tack imbedded in the bottom of the patient’s foot, of which he was entirely unaware as he could neither feel nor hear it. 48 hours later half his foot was amputated.

Diabetes is the leading cause of lower extremity (toe, foot or lower leg) amputation in the United States. People with diabetes should take special care to protect their feet!

 

This means educating patients on:

  Wearing appropriate shoes that do not pinch, rub or restrict their feet.

  Testing bathing water with a thermometer to avoid burns, and having water heaters set to 120 degrees to reduce risk further.

  Making sure to wash and inspect their feet daily and dry them thoroughly before putting on socks or shoes.

  Trim toe nails straight across to avoid ingrown nails and have callouses removed by a podiatrist.

 

Clinicians should be screening their patient's feet at every encounter to check for changes in color, texture, temperature or sensation (using a monofilament test). This is not just the job of a podiatrist--it is the job of all clinical professionals! I know of a fantastic eye doctor who did monofilament sensory checks on all his patients with diabetes at every eye exam and was often able to refer them for treatment because of what he found, saving limbs, and lives.