Can unsteady gait problems be corrected? 

Unsteady gait can absolutely be improved, at any age. Balance is like any other physical skill—it can be developed, and the more you use it, the less likely you’ll lose it. Simple exercises, such as walking heel-to-toe or standing on one leg, can be incorporated into your daily routine and can greatly improve your stability. Stretches that improve range of motion in your hips, knees, and ankles can also help you regain a strong gait. If you’re looking for some fun, tai chi and yoga classes are another great way to improve your balance and confidence. When instability is caused by mechanical problems with your feet, we can provide services such as physical therapy or tools such as arch supports and orthotics to steady your stride. One tool we love is the More Balance Brace, which can help seniors reduce their fall risk by 30 to 60 percent. For help improving gait abnormalities, instability, or balance issues, call Dr. Darren Silvester of Next Step Foot and Ankle Clinic in Pleasanton, TX today at 830-569-3338. We even offer free fall risk assessments, so if you have any concerns, please don’t hesitate to stop by and see how we can help.  Why are my toes tingling?  FAQ: Neuropathy Toes tingle for many reasons, though the most common source is some kind of nerve issue like tarsal tunnel syndrome or Morton’s neuroma. Injured, pinched, compressed, or irritated nerves can misfire and develop a painful, tingly, pins-and-needles sensation. In a condition like tarsal tunnel syndrome, one of the main nerves running into your foot from your lower leg ends up pinched in your ankle, which can lead to tingling throughout your whole foot.

Other common causes include peripheral neuropathy (particularly from diabetes), poor circulation, vitamin deficiencies, autoimmune diseases, and even alcoholism. Sometimes tumors press on a nerve and cause damage. Kidney or liver issues, hormone imbalances, and chronic inflammation can lead to tingling toes as well. To properly treat your discomfort, you need to have the exact cause diagnosed. Let Dr. Darren Silvester at Next Step Foot & Ankle Clinic help you address your nerve-related discomfort. Use our online form or call (210) 375-3318 to make an appointment with us. Photo credit: satit_srihin via Is neuropathy preventable?  If you have diabetes, you may have wondered at some point, “Is neuropathy preventable?” The good news is that you can prevent this nerve damage. This is possible by managing your blood sugar levels. High and fluctuating sugar levels damage the nerves, so by staying in a healthy and stable range, you can prevent the onset or progression of neuropathy. Investing in good diabetic foot care, avoiding injuries, and checking your feet every day for changes is also important. Work to stay active as well—this helps your circulation, which provides the nutrients your nerves and tissues need to stay healthy. If you notice any changes, or start experiencing pain, don’t ignore it. Contact Dr. Darren Silvester at Next Step Foot & Ankle Clinic in Universal City and Pleasanton, TX, for more information or an appointment to investigate the possibility of neuropathy and what can be done to manage it. Don’t risk the permanent damage. Call us at (210) 375-3318 or submit your information to our online request form. What causes neuropathy?  There are many different causes of neuropathy. Anything that impairs or damages nerve functions can lead to it. Diabetes is one of the most common culprits for nerve pain in the feet, but alcoholism, autoimmune diseases like rheumatoid arthritis, trauma from an injury, tumors, poisons, and vitamin deficiencies can all lead to dysfunctional nerves. No matter the cause, the symptoms are usually similar: burning, tingling, shooting pains, numb patches, trouble determining temperature, and even muscle weakness. How the condition is treated, though, is dependent on the underlying issue that gave rise to the problem. If you notice any strange pains or numbness in your feet, don’t ignore it. Neuropathy can be quite serious and result in a variety of complications if not accommodated. Contact Dr. Darren Silvester at Next Step Foot & Ankle Clinic in Pleasanton, TX, for more information or an appointment to deal with any nerve issues right away. Call (210) 375-3318, or fill out the website contact form to reach us.

What about surgery for my neuropathy?  Surgery is not indicated for “neuropathy.” However, many patients (especially diabetics, but many others as well) have nerve compression in addition to neuropathy. You have probably heard of carpal tunnel syndrome in the hand. The same thing can happen in the feet. This is especially true for diabetic patients. In fact I have seen patients diagnosed with neuropathy that only had nerve compression. If a patient demonstrates nerve compression in addition to, or instead of neuropathy surgery to free up the compression on these nerves can be very helpful. We have recently added new equipment in our office so this surgery can be done in a minimally invasive way with a scope. We are very excited to offer this new procedure that requires a shorter recovery and less wound complications to our patients who suffer from nerve compression related pain or numbness!

Is electrical signal therapy covered by insurance? 

Our current Electrical Signal Therapy with Integrated Nerve Block protocol is a self-pay model.  We do not bill insurance for these services.

What if I am not better in 13 treatments of electrical signal therapy? 


The treatments can be extended if you have not fully responded after 13 treatments. If you have not shown improvement by 20 treatments it is unlikely that this therapy will be helpful for you.

How can I tell if electrical signal therapy is working and how fast does it work? 

Some people feel improvement after only one treatment. Most people start feeling different after 4 to 6 sessions. Every person reacts differently. Patients often state they are having sensations in their legs that they have not had in a long time. Some people feel numbness going away, while some have less pain and more flexibility. Many patients state they can walk much farther without pain. Each patient describes the experience differently. The key is being consistent with the treatments. Being patient and consistent makes all the difference. Does electrical signal therapy help with numbness?  Yes. The results with sensation restoration have been encouraging. About 25% of patients show improved nerve conduction studies after only 8 weeks of treatment. Nerve biopsies show improved nerve densities in about 25% of patients after 8 weeks. So it appears that nerves do, in fact, heal and become more sensitive.

How does electrical signal therapy work?  The exact mechanism of how it works is not well understood. Our best theory has to do with cell membrane “gates.” A nerve cell is just a long chain of gates that open and close when it is stimulated. This allows ions (charged atoms) to pass through the gate. The body normally keeps the gates shut. The EST forces them open for an extended period of time. This allows for increased nutrient import and toxin export in the cell. The anesthetic closes the gates for a long time after the EST. Perhaps this allows time for the cell to heal and use its energy toward cellular repair rather than opening and closing gates or pumping ions. Is electrical signal therapy safe?  If you have a pacemaker you cannot have EST. But otherwise it is very safe. Injection site problems have been reported but they are very rare.

What do I have to do for electrical signal therapy?  The treatments are twice a week and last about 30 minutes. You cannot miss treatments, or the procedure does not work. If you are unsure you can consistently come for the therapy then wait until you are sure. Wear loose pants or shorts to the treatments. We then have to put electrodes on your skin. Don’t put any lotion on your legs or feet the day of your therapy, as the electrodes won’t stick. Are other treatments involved in addition to electrical signal therapy?  Yes. We also implement nutritional supplements and nerve testing. Some patients may have nerve compression and require surgery. Nerve testing is performed before and after treatment is involved. The tests we use are not painful and measure sweat response and sensation. Neuropathy is usually caused by multiple factors: biochemical, mechanical (nerve compression like carpal tunnel in the hand), cellular, and biomechanical. We try to address all of these. We believe this is why we have success in treating most patients. Is electrical signal therapy treatment effective?  We have seen patients who had neuropathy for 25 years experience significant improvement in their symptoms. Clinical studies with more than 100 patients demonstrate about a 90% success rate at significant or total pain relief if the patient follows the full course of therapy. In this same study, patients who were followed for a year maintained pain relief in 25 of 26 cases (Practical Pain Management April, 2012). What is electrical signal therapy?  Electric signal therapy is a treatment used for neuropathy. Using an electro-medical device, electrodes are attached to your skin in your legs. Local anesthetic blocks are also used. This involves multiple injections in your legs. For about 30 minutes, electrical signal will be generated in your legs following the course of your nerves. Most of the time, he will not feel this electrical signal because the frequencies are so high that the nerve does not detect the stimulation. The frequency and amplitude of the electrical signal is varied throughout the entire treatment. This keeps the nerves guessing and responding to therapy. It should not be painful. However, patients may experience sensation and even some discomfort. This is usually only a very short period of time during the treatment.

If you suffer from painful sensations caused by diabetic neuropathy, Dr. Darren Silvester of Next Step Foot & Ankle Clinic in Pleasanton and Universal City, Texas. Call our Pleasanton office at 830-569-3338 or our Universal City office at 210-375-3318, or write to us online, to learn more about electrical signal therapy and schedule your first appointment with us.