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  • Writer's pictureDr. Ndidi Ufondu, DPM

Neuropathy in the feet: signs, management, and patient education



Peripheral neuropathy, damage to the peripheral nervous system, frequently affects the feet and can severely impact quality of life. This extensive guide will explore the causes, symptoms, diagnosis, and array of treatment options for various neuropathic foot conditions. It also provides in-depth self-care education for patients learning to live with nerve damage in the feet.


Understanding Peripheral Neuropathy


Peripheral neuropathy is nerve damage that occurs in the vast communication network outside the brain and spinal cord. It develops when peripheral nerves become damaged or diseased, disrupting critical communication between the central nervous system and extremities.


There are over 100 different causes of peripheral neuropathy. Some common ones include:

  • Diabetes - the most prevalent cause. Over 50% of diabetics develop neuropathy.

  • Autoimmune diseases like rheumatoid arthritis where nerves are inflamed.

  • Infections including HIV, hepatitis, Lyme disease.

  • Nutritional deficiencies in vitamin B12, folate, thiamine.

  • Toxins from chemotherapy, heavy metals, drugs.

  • Inherited disorders like Charcot-Marie-Tooth disease.

  • Nerve compression syndromes like carpal tunnel and Morton’s neuroma.

  • Idiopathic - no known cause.


Neuropathies are categorized by the type of nerve fibers involved - sensory, motor or autonomic. Most involve a combination.


Why the Feet Are Prone to Neuropathy


Several factors make the feet extremely vulnerable to peripheral nerve damage:

  • The feet are the farthest extremity from the central nervous system so nerve signals have the longest distance to travel. This makes them more likely to get disrupted along the way.

  • The high density of nerves in the foot’s anatomically complex structures increases chances of compression and entrapment.

  • Weight bearing and ambulation expose foot nerves to repetitive microtrauma daily.

  • Feet endure extremely high levels of use and physical stress.

  • Medical conditions causing neuropathy like diabetes usually affect the small blood vessels first. Diminished blood supply starves nerves of oxygen.

  • Foot deformities like bunions, hammertoes, and flat feet alter biomechanics and put pressure on nerves.

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Signs and Symptoms of Neuropathy


Neuropathy manifests through diverse sensory, motor and autonomic symptoms. Common presentations in the feet include:


Sensory Changes

  • Numbness, tingling, burning, sharp shooting or electric shock pains, hypersensitivity, lack of hot/cold perception.

  • Lack of pain sensation enables injuries to go unnoticed.


Motor Changes

  • Muscular weakness, cramps, spasms, loss of ankle reflex.

  • Gait instability, balance problems, clumsiness, risk of falls.


Autonomic Changes

  • Abnormal sweating - either excessively damp or dry feet.


Additional Symptoms

  • Ulcers, wounds slow to heal due to lack of sensation and poor circulation.

  • Fungal infections, cracked skin.

  • Deformed toes, bunions, and hammertoes from imbalanced foot muscles pulling bones out of alignment.


Diagnosing the Cause


To pinpoint the reason behind neuropathic feet, podiatrists utilize:


  • Medical history review – identifies risk factors and progression of symptoms.

  • Neurologic exam of the feet assesses sensation, strength, reflexes.

  • Quantitative sensation testing with tools like the biothesiometer or monofilament.

  • Imaging studies like MRI detect nerve compression.

  • Nerve conduction studies analyze how well electricity travels through nerves.

  • Bloodwork screens vitamin levels, blood sugar, kidney function.


Treatment Options



Though progressive, several treatments can provide symptom relief and protect the feet:


Medications

  • Oral medication for pain relief - gabapentin, duloxetine, Lyrica

  • Topical capsaicin creams and lidocaine patches

  • Steroid injections directly into inflamed nerves

  • Medications to treat underlying causes like diabetes or autoimmune disorders


Orthotics and Braces

  • Custom shoe inserts redistribute weight off sore spots.

  • Braces provide extra stability and balance assistance.

Physical Therapy

  • Ultrasound, TENS, massage target sources of pain.

  • Stretching and strengthening improve mobility.

  • Gait training assists with balance.


Surgery

  • Release compressed nerves through procedures like neuroma resection.

  • Correct bone and joint deformities putting pressure on nerves - bunions, hammertoes.

  • Stabilize loose, unstable joints with fusions.


Lifestyle Measures

  • Wear proper footwear - cushioned, sized correctly, wide toe box.

  • Check feet daily for wounds since pain sensation is dulled.

  • Use moisturizer to prevent cracked skin.

  • Avoid going barefoot.

  • Trim nails to prevent ingrown toenails.

  • Optimize glucose levels and blood flow through diet, exercise, not smoking.


Caring for Neuropathic Feet: Essential Patient Self-Care Tips


Due to lack of sensation, dependent edema, and poor circulation, caring for neuropathic feet demands vigilance. Patients must examine their feet daily and protect them from harm. Self-care tips include:


Inspect Feet Daily

  • Check for cuts, blisters, bruises, puncture wounds which can go unfelt. Look between the toes.

  • Watch for signs of infection - redness, warmth, swelling, drainage.

  • Monitor for non-healing ulcers which require prompt medical attention.

  • Use a magnifying mirror to see the bottom of feet.

  • Feel for foreign objects stuck in the skin.


Practice Proper Hygiene

  • Wash feet daily in lukewarm water. Avoid very hot water which can burn numb skin.

  • Use gentle soap and thoroughly dry feet well with a soft towel, especially between toes.

  • Apply moisturizing lotion to prevent cracked skin but avoid getting cream between the toes.

  • File corns and calluses gently with a pumice stone after bathing when softened. Don’t cut corns or calluses.

  • Cut straight across toenails regularly to avoid ingrown nails.


Select Proper Footwear

  • Wear shoes at all times, even indoors, to prevent injury.

  • Shoes should have a wide, roomy toe box to avoid compression.

  • Avoid shoes with seams over toes or thin soles with no cushioning.

  • Ensure proper shoe sizing to prevent irritation - feet often swell throughout the day.

  • Break in new shoes very gradually.

  • Wear clean, dry socks. Change if sweaty. Avoid overly tight socks.

  • Wear slippers or shoes in the shower. Walking barefoot risks stepping on objects without noticing.


Lifestyle Tips

  • Put feet up when sitting to reduce dependent edema.

  • Follow physical therapy exercise program to improve mobility.

  • Do gentle foot stretches and massages to stimulate circulation.

  • Quit smoking and limit alcohol to optimize peripheral blood flow.

  • Be more cautious when walking on uneven terrain where it’s harder to sense the ground.


Seeking Help


Consult a podiatrist promptly if you notice signs of infection, ulcers, or wounds on the feet. Neuropathic feet require extra care and vigilance. Patient education on proper self-care reduces complications and improves quality of life.


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