“Doc, my feet are burning,” is a complaint I hear from my diabetic patients on a regular basis.
Symptoms of burning, tingling, or decreased feeling in the feet are common presentations of a disease known as diabetic neuropathy. Diabetic neuropathy can be described as a nerve pain that occurs in the peripheral portion of the body, meaning hands and feet.
According to the American Diabetic Association 1.5 million Americans are diagnosed with diabetes on a yearly basis. Diabetes is a progressive disease and, when not well controlled, leads to devastating side effects. Once a person has the diagnosis of diabetes it becomes crucial to keep blood glucose levels well controlled to prevent the development of diabetic neuropathy.
Diabetic neuropathy is caused by sugar by-products affecting the nerves. The initial sign is often a burning or tingling sensation in the feet. This progresses to a lack of feeling throughout the feet, putting the affected person at increased risk for cuts, pressure sores, and ulcers.
As a diabetic, the body’s ability to fight infection is compromised; therefore, when a patient develops an ulcer it can become infected and lead to life-changing events. A diabetic ulcer has the ability to move into the bone causing osteomyelitis, a fancy word for infection of the bone. A person who develops a bone infection can require long-term antibiotic therapy and possibly surgery, even amputation, meaning removal, of the lower extremity. If that happens, the diabetic person’s mobility obviously becomes more limited.
These limitations place the person at increased risk for developing pressure ulcers, weight gain, depression, and other diseases.
The question then becomes how to prevent diabetic neuropathy and the complications associated with diabetic neuropathy.
First, do all we can through diet control, exercise, and weight loss to prevent the development of diabetes.
Second, patients already diagnosed with diabetes should continue with life-style modifications, maintaining an A1C less than 7.0, taking medication as prescribed, regular visits with the physician, and daily monitoring of the feet.
Since persons with diabetic neuropathy often lack feeling in their feet they should wear protective shoes at all times. Wearing protective shoes, even indoors, helps prevent damage to the feet from stepping on objects.
Monitoring water temperature, specifically bath water, prevents patients from burning their feet, as often times patients cannot feel the heat.
Patients should report any changes in their feet to their physicians.
Physicians should monitor their patient’s diabetic neuropathy through testing of the patient’s sensation in their feet and inspection of their feet at regular office visits.
Patients with diabetic neuropathy may benefit from medications to help with their pain but no cure currently exists. Common medications used for diabetic neuropathy include gabapentin, pregabalin, amitriptyline, or duloxetine. Pain medications, such as hydrocodone, is not beneficial in treating diabetic neuropathy.
For patients struggling with diabetic neuropathy a referral to a podiatrist, a physician who specializes in foot care, may provide additional benefits.
Individuals with diabetes who are experiencing decreased feeling, burning or pain in their feet should talk to their physician at their next visit.