Neuropathy can be a life changing and overwhelming condition for some of our patients.
The causes are varied but the most common include diabetes, back injuries, tarsal tunnel syndrome, chemotherapy, idiopathic causes, vitamin deficiencies, thyroid concerns etc.
As podiatrists, we are concerned with the preservation of your feet and therefore the prevention of wounds subsequent infections and the common result of amputation of toes and/or the foot.
When dealing with neuropathy, the first step is to identify the cause. We run a large panel of blood tests to rule out the most common metabolic causes. Nerve conduction or PSSD testing can help diagnose nerve entrapment issues. Another common test we use is called Sudoscan. This is a simple test that demonstrates the sweat glands response in your skin to a small electrical stimulus. This helps us determine if the small nerves / autonomic nerves of your extremities are involved. If they are, it is very likely that Diabetes may be the cause of your neuropathy.
In general, if the causes of your neuropathy have been identified and dealt with (ie better blood sugar control, vitamin deficiencies remedied, back/spine evaluated, entrapped nerves released etc), then we move on to treating the nerve pain directly.
There are two main medical treatment options. Either we make the pain improve with oral pain medications or we try to improve the nerve health itself and therefore the pain and numbness.
Covering the pain to allow for better sleep, exercise and ambulation may involve drugs such as lyrica, gabapentin, cymbalta, duloxetine etc. Theses are not normally habit forming and can be used long term. Narcotic coverage of this kind of pain is a last resort.
The other medical treatment is focused on helping the nerves to recover and improve function. The most common prescription we use is Metanx. This is a patented highly concentrated Vitamin combination that has been shown in repeated studies to improve sensation, bloodflow, wound healing and reduce pain involved with neuropathy.
Our current protocol is to test the nerve function with Sudoscan and have patients take the Metanx twice per day for six months at which time we test again with the Sudoscan. If quantifiable improvement can be demonstrated we encourage the patient to keep taking Metanx and to be retested in the future. As long as improvement in nerve function can be seen, our hope is that enough feeling will be developed in the feet to help patients feel any wounds or infections starting early enough that we can intervene long before amputation enters into the picture.
Our goal is zero amputations, and by restoring nerve health and close monitoring we hope to achieve this lofty goal.
When neuropathy appears, patients are at risk of many complications. Below you can read about the valuable role a Podiatrist can play in the prevention and treatment of foot and ankle complications.
QUALITY OF CARE
• Persons visiting a podiatrist and/or a lower-extremity clinician specialist within a year before developing all-stage complications were between 23 percent and 69 percent less likely to have an amputation compared with individuals who visited other health professionals.
• Podiatrists provide a unique and valuable service that is distinct from the services that allopathic and osteopathic physicians provide, and provide the highest benefit to those persons at risk of lower extremity complications as a consequence of diabetes.
• Conclusion: Care by a podiatrist and/or a lower extremity clinician specialist in the year before the lower extremity complication diagnosis reduced the potential for undergoing lower extremity amputation, suggesting a benefit from multidisciplinary care.
Thomson Reuters Study:
• Podiatrists see patients who are sicker and have more comorbidities.
• Among non-Medicare patients with foot ulcer, those seen previously by a podiatrist had a 20 percent lower risk of amputation and a 26 percent lower risk of hospitalization compared with patients not previously seen by a podiatrist.
• Among Medicare eligible patients with foot ulcer, those seen by a podiatrist had a 23 percent lower risk of amputation and a 9 percent lower risk of hospitalization compared with patients not previously seen by a podiatrist.
• Conclusion: Care by podiatrists prior to the first evidence of foot ulcers in patients with diabetes prevents or delays lower extremity amputations and hospitalizations.
Dan Preece, DPM
Dan Preece DPM & Darren Groberg DPM
Foot and Ankle Specialists