Have you ever stopped to think about how important your feet are?
They connect you to the earth, move you around, and play host to a variety of sensations: cool water, a sandy beach, or tickling fingers, to name a few. For those who suffer from diabetic neuropathy, the world can be a dangerous place, devoid of these and many other sensations.
If you are a diabetic, then you have probably heard from one of your doctors about the complications of diabetes. Among the most common and severe side affects is neuropathy, which will occur in approximately 50% of diabetics even with controlled blood sugar. Diabetic Neuropathy is a lack of sensation that affects the diabetic’s extremities. Typically the lower extremities are affected first.
The Center for Podiatric Medicine understands diabetic care, and offers the latest treatments to our patients including:
- Quantative Sensory Testing (QST)
- Epidermal Nerve Fiber Density Testing
- Diabetic Management
- Diabetic Shoes
- Medical Pedicures
These treatments, including surgical nerve decompression and near infrared technology, have been shown to reverse the progressive symptoms of neuropathy. In fact, these new approaches have been highlighted and syndicated nationally on WGN Television, Univision, and in Newsweek Magazine.
Symptoms of neuropathy
Symptoms of neuropathy are the lack of normal sensation that affects extremities. Patients may have a noticed weakness or loss of balance. Numbness, tingling and pain of the heel, the arch, the ball of the foot and the bottom and tips of the toes occurs. Lack of feeling to the diabetic foot is the leading cause of ulcerations, infections, and slow healing wounds and in advanced cases amputation of the toes, feet and legs.
Causes of diabetic neuropathy
The first reason a diabetic nerve becomes compressed is that the nerve is swollen as a result of sugar from the blood stream entering the nerve. This sugar called glucose, which gives the nerve energy is converted into another sugar called sorbitol. Sorbitol’s chemical formula makes it attract water molecules. This water that is drawn to the nerve causes swelling. The swelling in areas that are already anatomically tight causes compression of the nerve.
Another reason for neuropathy in a diabetic is the failing transport system. This system sends chemical messages within the nerve. When this system is failing, the nerve loses its ability to send and relay these messages. Thus when damaged by compression, the nerve is not able to repair itself.
Quantitative Sensory Testing
In the past, physicians were limited on treatment for patients with diabetic neuropathy. Medication to dull the nerve sensation to make the patient more comfortable was the primary treatment protocol.
With today’s latest technology, physicians have the tools necessary to accurately determine the degree of neuropathy and pinpoint the specific nerve(s) affected. Quantitative Sensory Testing (QST) assists doctors at CPM to reverse and even stop the progressive symptoms of diabetic neuropathy. This testing process aids the surgeons in determining which patients are candidates for nerve decompression surgery. This test is the first step in determining a proper treatment protocol.
Decompression surgery is the procedure to open up tight areas through which the nerve passes, by dividing a ligament or fibrous band that restricts the nerve from functioning properly. This gives the nerve(s) more oxygen and better blood flow. The current statistical success rate is 80% for the lower extremities.
The surgery does not change the underlying metabolic process that makes the nerve susceptible to compression in the first place. When decompression is done in the early stages, restoration of blood flow to the nerve will stop the numbness and tingling, and enables a patient to recover some lost strength. If the decompression is done later in the course, when nerve fibers have begun to die, the decompression allows for the diabetic nerve to regenerate.
Generally this procedure is done under “twilight” anesthesia in an outpatient surgical setting. The surgeon wears magnified operating glasses to perform the operation. The special technique utilized in nerve compression surgery usually takes about one and a half hours but can vary depending on the individual patient.
CPM offers free educational seminars to explain the latest in neuropathy treatments and diagnosis. Please watch this website for the next scheduled seminar announcement for dates and locations, or please call our main office.
Who is a candidate?
This treatment protocol is right for you if you are a diabetic who is beginning to experience the symptoms of numbness, tingling in the feet and who may have noticed weakness, loss of sensation or loss of control of some of the muscles in the feet. In addition, overall health is taken into consideration with coordination of care with your primary physician.
We would like to thank Dr. A. Lee Dellon of The Institute for Peripheral Nerve Surgery, Baltimore, MD., for the training and education on his approach to diabetic neuropathy.
“I was afraid that I was going to lose my toes, or worse, and now I can actually move my toes and it feels normal”
“I had problems for so long and no one in the medical community offered to help until I found Dr. Jones”
“I am 100% better and I am back to work a couple of hours per day,” “I don’t have pain like I had before”, “I am very happy that I had the surgery done”.
“After the anesthetic wore off I began to have sensations in my foot that I haven’t had for years”, “I was impressed”.
Intra-epidermal nerve density testing: a small, 3mm punch biopsy is revolutionizing early diagnosis and treatment. When EMG/NCV is often vague, this new test is specfic. In time, this will be the gold standard. And you can be tested now!!
Diabetic nerve decompression surgery: restore protective sensation via outpatient surgery to relieve the compression on the nerves. Dr. Jones was highlighted on WGN television for this surgery and has had patients frm as far away as Washington State and New Mexico.
Anodyne Physical Therapy: Improves peripheral nerve flow
Wound care and reconstructive surgery: Use of new materials has proven extremely effective in managing difficult-to-heal wounds. And, when needed, surgery is offered to help prevent limb threatening conditions.
For conditions not qualified by Medicare or primary insurance, we have a lower cost alternative to foot care. Medical pedicures reduce nails, trim calluses, and improve foot hygiene. We offer these special solutions at a reduced cost. And, if a medical need arises, the patient will be referred to our physicians.
Diabetic shoes and insoles are prescribed, fitted, and managed right in our offices. Under the direct guidance of our physicians, each patient is examined so that the appropriate shoe gear is chosen. We then follow up and review their shoes at every visit with new shoe gear prescribed yearly.