Diabetes and Nerve Damage

By Brian P. Bach, DPM

Diabetic patients often get signi?cant nerve damage. Usually this happens when the blood sugars are elevated. However, it can also occur in any diabetic patient, especially ones that have been diabetic for quite some time. This nerve damage is called diabetic neuropathy.

Initially, the blood sugars may not be too bad and there is no nerve damage, and the patient has good sensation and feeling. When the blood sugar stays elevated the nerves start to get damaged, and the patient may have tingling, or strange feeling in the feet. As the sugars remain elevated the nerves get more damaged and essentially get burned out. The patient then loses all sensation and feeling in the feet.

There is no great cure for diabetic neuropathy other than strict blood sugar control. For some early occasional tingling, some over-the-counter creams can be tried. If this does not work, there are prescription medications that can be taken. All of these do not particularly cure the problem, but can alleviate some of the discomfort.

The real problem regarding feet and legs occur when the patient loses sensation and feeling. The patient may step on something and not feel it. The feet can get irritated in shoes and the skin can breakdown and ulcerate. Diabetics must check their feet daily and if they see any open areas, they must contact their podiatrist immediately. These areas will not heal by themselves or with home treatments.

Another problem that happens with diabetic neuropathy is that the bones in the feet and ankle can simply break and collapse. The patient will not even feel this because of the neuropathy. The foot may look swollen and even have open wounds on the bottom or side of the foot or ankle. This is called a Charcot foot. This must be urgently attended to by their podiatrist.

Initially some types of braces can be used for this to stabilize the foot and ankle. If this is not working there are very new surgical procedures that can permanently fix these collapsed bones and also cure any ulceration(s) that occur because of it. If the diabetic patient has any of these symptoms they should contact their podiatrist for help.