Diabetic Peripheral Neuropathy

Our nerves are responsible for our ability to feel, detecting even the lightest sensations, like a feather being moved across our toes. When our nerves are damaged, our ability to feel can fade, become mixed up, and may eventually be lost altogether. This is called peripheral neuropathy. 

Neuropathy can feel like numbness, burning, tingling, or pins and needles in the feet. The most dangerous sensation change is the complete absence of feeling, as opposed to a numb feeling where you still detect pressure and other changes. An absence of feeling means that you can sustain a cut or other wound or injury, not know it’s there, and not take the right measures to disinfect it, dress it and let it heal. This makes you vulnerable to infection, ulceration, and even amputation. This is a big part of the reason why here in the UK, someone with diabetes has a toe, foot or leg amputated every hour.

In the case of diabetes, it is the uncontrolled high sugar levels in our blood vessels that damages the nerves over time and disrupts their ability to send clear messages about what is being felt at the feet. This is thought to be related to chemical reactions caused by the high sugar levels. Additionally, high cholesterol and triglyceride levels are also associated with increased risk of neuropathy, and research has found that some genetic traits may make a person more susceptible to nerve damage.

When peripheral neuropathy occurs in someone who does not have diabetes, it may be linked to:

• Nerve injury
• Infection
• Alcoholism
• Systemic conditions, autoimmune and other diseases
• Exposure to toxins
• Side-effects of particular medications
• Poor nutrition and vitamin deficiency

The best way to manage your peripheral neuropathy at home and slow its progression is to manage your diabetes and blood sugar using your diet, exercise, and any medications you’ve been prescribed. To help protect your feet from the complications of peripheral neuropathy, we also recommend:

• Checking your feet daily for any new undetected marks, spots, cuts, swelling or redness
• Holding your feet up to a mirror if you can’t see the bottom of your feet to check for anything out of the ordinary
• Washing feet your feet every day, carefully drying them thoroughly, especially in the spaces between the toes
• Moisturising your feet (ideally after showering and before bed) to help promote your sensation (hard, dead skin reduces sensation)
• Wearing well-fitting shoes that have a good width and depth, both inside and outside of the house, to minimise your risk of damage
• Avoiding walking around with bare feet
• Using socks that wick moisture away from your feet
• Avoiding bringing your feet in direct contact with heaters, hot water bottles, scalding hot showers/baths and electric blankets, as they may cause burns that you cannot detect

Here at Matt Raden Podiatry, we take diabetic peripheral neuropathy very seriously, and work closely with you to help you get the best control over your foot health and help you avoid the associated risks and complications.

A key way that we support you is with an annual diabetic foot health check, where we assess the status of your sensation and circulation, discuss your symptoms and what they mean when it comes to protecting your feet, and give you advice on how to best manage your symptoms and maintain your foot health. As the symptoms of diabetic peripheral neuropathy worsen over time, it’s important to have the right information and tools to help you care for your feet in light of their current state. 

We also provide various treatments to promote the foot health of those with diabetic peripheral neuropathy while reducing their complication risk, including:

• Corns and callus removal (these can build up and cause pressure that then leads to injury)
• Cracked heel treatment (cracks in the heels can crack the healthy skin beneath and make you vulnerable to infection) 
• Trimming and thinning thickened or elongated toenails
• Checking if your biomechanical foot function is putting you at risk of injury, such as having prominent joints that are being overloaded
• Using custom foot orthotics to offload the feet and offer better support and comfort
• Recommending good, supportive and cushioning footwear that matches your foot type