The effect peripheral neuropathy can have on one's feet can be profound. Essentially a disease of sensation, peripheral neuropathy can lead to numerous foot problems, making prevention through proper foot care vitally important. This article will review what causes peripheral neuropathy, and will discuss the symptoms of peripheral neuropathy in the feet and legs. Finally, it will explain what measures can be taken to protect the feet from harm.
Peripheral neuropathy is a broad term describing disease of the nervous system outside the brain and spinal cord. While it typically refers to abnormal nerve function in the legs, it can also refer to symptoms in the arms and hands as well. The overall disease can have many different causes, but the underlying symptom in common is decreased sensation. Decreased sensation can take on a broad definition with multiple levels of severity. In some cases, the decreased sensation is imperceptible to the person with peripheral neuropathy and is noticeable only on a medical exam. Testing for inabilities to feel the difference between a pin-prick and a flat object, vibration, and light stroking touch can reveal the sensation loss. On the other hand, peripheral neuropathy can also lead to outright numbness. The foot can feel heavy, padded, swollen, or creased as a result of this numbness. More advanced cases of peripheral neuropathy actually have painful sensations as part of the symptoms. These include burning pain (like the foot is on fire), tingling (like the foot is waking up from 'being asleep'), pins and needles poking sensation, and sharp, shooting, electrical pains. The most advanced cases affect the way the diseased nerves control the muscles of the leg and foot. Cramping, weakness, minor balance loss, and muscle wasting can be seen in severe cases of peripheral neuropathy. Even the skin is not spared the effects of peripheral neuropathy, as the nervous system controls automatic functions like sweating through the autonomic nervous system. Decreased nerve control leads to less sweating and oil production, leading to dry and cracked skin as a direct result of peripheral neuropathy.
SEVERS DISEASE
The conditions that cause peripheral neuropathy are numerous and broad. They include diabetes, which is the most common cause currently, as well as spinal disease, strokes, polio, vitamin B and folate deficiencies, infectious diseases like syphilis, certain medications, chemotherapy for cancer, surgical or radiological nerve damage, and a wide variety of neuromuscular disorders like muscular dystrophies, multiple sclerosis, and cerebral palsy. Another cause is genetic and not well understood. Known as idiopathic peripheral neuropathy, this condition simply arises out of the blue without any discernable cause. In many cases, someone in the family has also had poor sensation, giving credence to a genetic cause developing later in life. All of the above diseases each can have slightly different symptoms associated with their peripheral neuropathy, given that the function of nerve tissue is affected in slightly different ways. However, the end result for the foot is generally the same for most all causes, with the exception of polio or neuromuscular disorders which are nearly always accompanied by foot deformities.
Treatment of peripheral neuropathy can vary depending on the cause. In certain conditions, like diabetes or nutrient deficiency, controlling the disease will control the neuropathy symptoms. Diabetic blood sugar has a direct role in creating the abnormal nerve function, and controlling the sugar levels reduces the disease. Likewise, if a nutritional deficiency is the cause of the neuropathy, restoring the proper nutrient levels can reduce the symptoms. In other cases, the symptoms can only be controlled medically, as the underlying disease is untreatable. In general, medical treatment does not reverse numbness, but can have a definite effect on pain, whether it is burning, tingling, poking or shooting. Traditional pain medications such as nonsteroidal anti-inflammatories, Tylenol or narcotics do not usually work well on neuropathic pain. The abnormal nerve function is often separate from the normal pain signals that these medications work on, and in the case of anti-inflammatory medications no inflammation is present to be reduced. There are several topical medications available to treat mild cases of peripheral neuropathy-related pain. These creams and gels contain hot pepper extract or menthol, and can alter pain sensation in limited ways through several mechanisms. Most cases however require medication that actually modifies the abnormal nerve signal. This includes anti-seizure or anti-depressant medications that are also FDA approved to treat peripheral neuropathy. Unfortunately, side effects in some individuals can limit their use. These include excessive sedation, leg swelling, and blurry vision. Alternately, there are some prescription nutritional supplements that can be used for multiple causes of peripheral neuropathy. Unfortunately, their overall effectiveness in the larger population is still being debated, as they may only work in a limited number of people.
Given the problems associated with peripheral neuropathy, proper care of the feet is important This is especially true in diabetics. The feet are at greater risk for skin wounds, infections that go unnoticed, soft tissue and bone injuries, and hot/cold injuries when there is poor sensation. To start, shoes must be worn at all times, including within the home. Objects on the ground or in carpet puncturing bare skin or feet in socks can go unfelt, which can eventually lead to tissue damage and infection if immediate attention is not given to the injured area. At times, small objects like needles or splinters can lodge themselves deep in the numb foot, and can remain there slowly brewing an infection unnoticed. For this and other reasons, the feet must be inspected regularly to ensure that there are no skin wounds, infection, or inflammation that may otherwise go unfelt. A simple thirty second self exam at night is sufficient, and a partner or hand mirror on the ground can be used if one cannot bend the foot up to evaluate it themselves. All foot or ankle sprains and strains need to be evaluated by a podiatrist soon after the injury to ensure the injury is not worse than assumed, as neuropathy can limit the pain of serious sprains and even fractures. It is not uncommon for a person with peripheral neuropathy to suffer a severe ankle sprain or foot fracture and not properly feel it at the time of injury. Bathing or soaking needs to be performed with some caution, as the temperature of the water can be incorrectly judged by a foot (or even a hand) with poor sensation. In order to be absolutely certain of the correct water temperature and to avoid scalding, the forearm should be used to test the water before the foot is placed in it. In cold weather, the feet must be well covered by warm socks and appropriate shoes, and should be kept dry. Frostbite can set in without being felt, leading to skin and tissue death that may require amputation. Finally, the skin also needs to be hydrated regularly with moisturizers due to the drier skin, and regular soaking should be avoided due to the drying effect soaking has on skin as it leaches essential oils from the skin surface. By performing the above prevention measures, one can adequately protect the feet from the harm peripheral neuropathy can indirectly cause.
Peripheral Neuropathy and The Feet SEVERS DISEASE
No comments:
Post a Comment