Neuropathy also known as nerve damage, is extremely prevalent in the diabetic community. Neuropathy is a very complex problem particularly in the diabetic setting. Diabetes causes plaque to deposit within the small arteries called arterioles that nourish small nerve endings. When these arterioles become blocked or narrowed nourishment to the nerve endings become reduced and may cause the nerve endings to become dysfunctional and die. There are a number of components to neuropathy that will be discussed below.
The first component of neuropathy is metabolic. A diabetic’s high sugar levels (hyperglycemia) can lead to a dangerous metabolic problem inside the nerve which blocks the electrical impulses from the nerve to the brain. As a result of this metabolic problem, diabetics may be unable to feel pain or temperature changes in their limbs. Because of the inability to feel pain or temperature, many diabetics may not realize they have a problem or have injured themselves. At Ocean County Foot and Ankle Surgical Associates, P.C., we often see patients that wear a pair of tight-fitting shoes for a long period of time, which result in a blister they cannot feel. This blister then evolves into an open ulceration with infection. Additionally, we see diabetic patients that twist an ankle, hurt ligaments or even fracture bones and have been unable to feel the pain. That is the danger of diabetic neuropathy.
Another component of neuropathy is that of motor dysfunction. Motor dysfunction results in the potential loss of muscle mass in the foot which may lead to atrophy of the tiny intrinsic muscles of the foot. Foot muscle atrophy often leads to what is commonly referred to as claw toe deformity or hammertoe deformities. Additionally, diabetes also makes tendons, ligaments and muscles lose their elasticity and become very hard and tight and begin to contract. To mitigate these impacts, it’s very important that diabetics participate in good stretching exercises every day, which may include yoga or Pilates to maintain their flexibility.
A third problem occurring as part of neuropathy is regulation of the autonomic nervous system. The opening and closing of the bodies blood vessels, which lead to the stimulation of sweat glands and regulation of heart rhythm is often affected by diabetes. Diabetics who have neuropathy will get very dry skin that may fissure and crack. Dry and cracked skin on the feet can sometimes lead to foot ulceration and open wounds that are difficult to heal.
Here at Ocean County Foot and Ankle Surgical Associates, we have a pathway to help patients with neuropathy. Our process begins with a history and physical and laboratory blood work to look at nerve function proteins as well as vitamin levels to determine if there are deficiencies that need to be addressed. Also of importance is properly fitting shoes. This is paramount as part of our treatment pathway. Extra depth diabetic shoes and, if necessary, molded diabetic shoes are very important to accommodate deformities such as bunions or hammertoes which helps prevent rubbing which could lead to blister or ulceration. Many patients are entitled to a pair of extra depth shoes or molded diabetic shoes, sneakers or work boots through Medicare and other insurance plans as they recognize the benefits of such preventive treatments. Ocean County Foot and Ankle Surgical Associate’s diabetic shoe fitting and bracing program is a full service program that will properly fit patients with the right pair of diabetic shoes or bracing if necessary.
If you are concerned that you may be affected with diabetic nerve issues in your lower extremities, please do not hesitate to come to the experts. We have the knowledge, skills and resources to assist diabetic patients with a variety of foot care concerns. We’re always happy to answer your questions about any of our treatment options. Please contact one of our convenient office locations today for an expert opinion.