Peripheral Neuropathy

Peripheral neuropathy is a condition that develops as a result of damage to the peripheral nervous system, the vast communication network that transmits information between the central nervous system (your brain and spinal column) and every other part of your body. When peripheral nerves are damaged, they don’t function properly (as you’d likely expect).

Symptoms of neuropathy ranges from numbness, tingling, or burning pain, to pins and needles sensations (paresthesia), and even to muscle weakness. Areas of the body may become abnormally sensitive (hypersensitivity). In such cases, pain can occur in response to stimuli that wouldn’t normally provoke pain, like water coming down in the shower or a gust of wind blowing across the skin.

An estimated 20 million people in the United States have some form of peripheral neuropathy.  The most common cause of peripheral neuropathy is diabetes. According to the American Diabetes Association, 60 to 70 percent of people with diabetes will develop neuropathy within their lifetime.

Besides diabetes, other potential causes of peripheral neuropathy include heredity, alcoholism, arthritis, advanced age, injury, neurological disorders, and even certain medications (including some chemotherapy drugs).

Those symptoms noted earlier are often the first sign of another problem (like diabetes) and should be reported to your primary care physician as soon as you notice them. If these problems arise in your lower limbs, come and see us for a professional diagnosis.

If the source of the neuropathy is diabetes, the nerve damage will typically occur in an ascending pattern. This means the first nerve fibers to malfunction are those that travel the farthest from the central nervous system. Often, pain and numbness are felt symmetrically in both feet, and are followed by gradual progression up the legs. The upper extremities (fingers, hands, and arms) tend to be affected later.

If you have peripheral neuropathy, it’s important to inspect your feet regularly. Decreased sensation can cause you not to notice an injury or infection. Someone who has diabetes and peripheral neuropathy (with loss of protective sensation), for instance, could step on a tack, develop a blister, or grow an ingrown toenail and be completely unaware of it. Regularly inspect your feet so you can note any injuries or infections, and then seek appropriate medical attention as needed.

In the event you’re unable to properly inspect your own feet, enlist a family member or friend to help you, or use a mirror. It’s essential that any injuries and wounds are treated promptly to prevent further damage or infection.

People with peripheral neuropathy should wear properly-fitted shoes and avoid walking barefoot to prevent injury. It’s also important to inspect shoes for excessive wear or damage, and for objects inside the shoes. If you have diabetes, the most important thing you can do is to keep your blood sugar under tight control. Take your insulin or medication as prescribed and follow the recommended diet.

A podiatrist, your family physician or your internist can diagnose peripheral neuropathy. The diagnosis is made on the basis of a physical exam, health history, and your symptoms. Lab work may be ordered to check your blood sugar level. We will perform a thorough foot check to look for any injury or infection, and will teach you how to do the same. People who have peripheral neuropathy should have their feet examined by a podiatrist at least once per year. If you also have diabetes, we will work closely with you and other health-care professionals. Controlling your blood sugar levels with diet, exercise, and medication (if needed) can slow the progression of peripheral neuropathy and maintain foot health.

There are options for treatment to slow the progression of the disease, maintain foot health, decrease painful symptoms, and improve quality of life.

• Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs, can relieve mild symptoms. For more-severe symptoms, prescription pain relievers and other medications may be needed. Anti-seizure medications—such as gabapentin (Neurontin) and pregabalin (Lyrica)—developed to treat epilepsy, may relieve nerve pain, but might also have side effects including drowsiness and dizziness.
• Antidepressants—such as amitriptyline, doxepin, and nortriptyline—have been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain. Duloxetine (Cymbalta) and the extended-release antidepressant venlafaxine (Effexor XR) also may ease the pain of peripheral neuropathy caused by diabetes. Side effects can include dry mouth, nausea, drowsiness, dizziness, decreased appetite, and constipation.
• Topical treatments—such as Capsaicin cream, Lidocaine patches, or compounded prescription creams—can lessen symptoms for some patients.
• NeuRx-TF, a vitamin supplement available at Eagle-Summit Foot & Ankle, is ideal for nerve function. This combination of powerful antioxidants containing Vitamin B6, Methyl B12, Benfotiamine, and Alpha Lipoic Acid helps protect nerve cells from oxidative damage related to aging and environmental stress. As a dietary supplement, NeuRx-TF TABLETS may help maintain healthy blood sugar levels and are recommended for diabetic patients.
• MLS Laser Therapy has shown promise in the treatment of painful symptoms associated with peripheral neuropathy. While more studies are needed to fully assess the efficacy, some possible explanations for how the laser therapy helps include the release of chemicals (endorphins) that reduce pain, reduction of swelling, and increased blood flow to involved tissues.