Neuropathy diminishes pain, sensations in feet

The condition is caused by poor blood-glucose control associated with diabetes

Dealing with neuropathy

• Keep blood glucose levels in your target range.

• If you have problems, get treatment immediately.

• Check your feet every day. If you can’t feel pain, you might not notice an injury.

• If your feet are dry, use a lotion on your skin but not between your toes.

• Wear well-fitting shoes and socks.

• Use warm water to wash your feet, and dry them carefully.

• Get special shoes, if needed. If you have foot problems, Medicare may pay for shoes.

• Be careful with exercising. Talk with a diabetes clinical exercise expert.

Source: American Diabetes Association, www.diabetes.org


It’s a very uncomfortable situation: the loss of sensation on your feet.

Not being able to feel whether the ground is hot or cold, or whether your shoes don’t fit right. Or worse, not noticing the damage you could be causing to your feet.

“When you realize you’ve lost pain, you are in trouble,” says Dr. Andrew Boulton, professor of medicine in the division of endocrinology, diabetes and metabolism of the University of Miami Miller School of Medicine.

Boulton has witnessed the consequences of not feeling pain.

The patient who walked around without noticing he had a nail through his shoe. Another one who took a stroll on the beach not realizing the hole slowly carved on his foot by the hot sand. Or the man who felt asleep near a chimney and woke up to the smell of something burning — his feet.

Boulton is an expert on neuropathy, a disease prompted by poor glucose control, among other factors. The condition causes nerve damage, impairing feeling in the foot.

Neuropathy acts similarly to an electrical circuit being disrupted. The nerves send messages to your brain about heat, cold, touch and pain. Nerves communicate how and when to move your muscles, and also have control over systems like sweat glands or digestive functions. So when these nerves are damaged, communication stops.

It’s important to take steps to prevent foot injuries, Boulton says.

“Use your eyes and look where you are walking,” he says. “All this is preventable. This doesn’t need to happen if you look after your feet.”

This is important advice since diabetes is the most common cause of foot ulcers, says Dr. Robert Kirsner, professor of dermatology at the University of Miami Miller School of Medicine.

“Because patients don’t have sensation, they may not have any symptoms,” Kirsner says. “That’s why it’s critical that patients with diabetes examine their feet regularly, and when they go to their physician, their feet get examined.’’

Ulcers or foot wounds can cause serious problems if they don’t heal because, in worst cases, this increases the chances of amputation.

“If we can heal the ulcer faster and better, those complications can be diminished,” he says. Eliot Prince, a patient of Kirsner, is well aware of the importance of looking after your feet.

The 47-year-old Miami native credits Kirsner for saving the toes on his left foot. About seven years ago Prince, who had been diagnosed with diabetes in 1992, had noticed that two toes on his left foot were darkening and had started to swell.

He went to Nassau, hoping that the salty waters of the island would heal his foot. He was putting his socks on when his hand slipped, removing some of the skin. He flew back to Miami the next day. At the hospital he was told it could be gangrene and that his two toes might have to be cut off.

“I didn’t have gangrene but if you would have seen them you’d thought I had gangrene because my toes were black.”

He wanted a second opinion, and a friend told him about Kirsner.

“He cut off the skin, examined it. He knew what he was looking for,” Prince says. Kirsner told him that the wound was treatable and prescribed him a cream that eventually healed his foot.

People with neuropathy can also develop ulcers. They have to wear special shoes to remove pressure from the wound, Kirsner explains.

“That’s the most important thing with neuropathic foot ulcers, to remove pressure off the wound,” he says.

Special shoes or boots improve the way people walk by making them take fewer steps and shortening the length of their stride.

Another foot-related complication is excessive dryness, a sign that the sweat glands aren’t working properly. In those cases, special moisturizers are prescribed to help deal with the discomfort. When you have dry, cracked feet, you are more likely to get a fungus infection, Kirsner explains.

Fungus cause microscopic changes on the skin; it’s an opening that allows bacteria to come in and cause an infection.

“A fungal infection on a diabetic patient is more important than in other patients because infections on diabetic patients have more complications,” Kirsner adds.

By Douglas Rojas-Sosa