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.