A diabetic patient who is experiencing tingling, numbness, pain, or complete loss of sensation in the feet may be experiencing peripheral neuropathy. The peripheral nerves act in order to communicate what the feet are sensing to the brain; however, if these nerves are damaged the communication is lost. Diabetes is one of the leading causes of peripheral neuropathy, but what actually causes the nerve damage is unknown.
Podiatrists are able to test for loss of sensation by doing a couple simple exam room tests. One of the tests to anticipate during the visit is the testing of reflexes with the tapping of the reflex hammer. Another is called the Semmes Weinstein 5.07 monofilament test, which the podiatrist will press a small filament to the foot to see if the patient can feel the filament touching the foot; this filament will cause no pain. Another simple test is by pressing a vibrating tuning fork to the patient’s foot to see if the patient is able to determine when the tuning fork starts and stops vibrating. If the patient has areas that are lacking sensation, this can be very dangerous for the patient’s foot health if not monitored.
Without the peripheral nerves functioning, the feet may not “know” that they are stepping on something or hurting and the brain will not be told either since the communication between the two is cut. For example, there have been cases where patients with peripheral neuropathy find foreign objects like golf balls, watches, matchbox cars, etc. in their shoes after wearing that shoe all day, week, month, or year long! This has very serious consequences because it predisposes patients to a higher chance of ulceration, which could then get infected and even end in an amputation if severe enough.
Unfortunately, there is currently no fast cure for the treatment of peripheral neuropathy, but the ulceration risk in patients with peripheral neuropathy can be diminished in several ways. First, before putting shoes, on be sure to check to make sure nothing has fallen into them. Keeping blood glucose levels well controlled, eating healthy, exercising, and not using tobacco products will also prove to be beneficial. Lastly, it is important to visit a podiatrist to receive meticulous foot care in which the podiatrist will be looking for pre-ulcerative and ulcerated skin on the foot. The podiatrist will be able to prevent the pre-ulcerative skin from ulcerating and provide wound care if an ulcer is already present to heal and keep the ulcer from getting infected.