What is neuropathy?
Neuropathy is characterized as numbness, weakness, and pain from nerve damage that is usually most described in the outermost areas of our bodies, typically in the hands and feet. It comes in many shapes and sizes, but it is NEVER normal. The most common term we hear when it comes to neuropathy is peripheral neuropathy, which most people link to diabetes since that is where diabetics start to lose feeling (in the tips of the toes or hands). It has been described as a stocking/glove distribution, or in other words, the loss of sensation is like you are putting on numbing socks that start at the toes and work their way up. This type of neuropathy is more commonly caused by diabetes or high levels of sugar in the blood that lead to damage of the nervous system, but it can also be caused by thyroid problems, alcoholism, cancer medications, and other drugs, or even nerve entrapment.
What are the signs of neuropathy?
Neuropathy can often manifest itself before we realize there is a risk of diabetes. The most important thing you and I can do is to not let things get out of hand before we try to address the issue. Nerves typically are not damaged overnight and the signs can creep up slowly. Some early signs of neuropathy can be as subtle as excessive dryness to the feet because the nerves to the sweat glands are damaged. Other signs are more severe such as numbness, burning, tingling, or electrical shocks. None of these symptoms are normal and must be addressed quickly as nerve rehabilitation is also not an overnight process.
What causes neuropathy?
When these symptoms manifest more quickly, or only show up on one side of the body, or appear in a localized area of the leg and foot, then we start considering that a nerve is getting pinched or “entrapped” on its course to the central nervous system. When a nerve is entrapped, then usually the damage to the nerve is the result of a lack of blood flow (ischemia). When a nerve is entrapped for too long, it can start to malfunction and the neuropathy symptoms begin. The good news is that when the nerve is freed of its entrapment site or is decompressed, then it can start to heal. The bad news is that the longer you leave a nerve entrapped, the longer the rehabilitation can take and less function can be restored.
How do we treat neuropathy?
Knowing why you have neuropathy–whether it be from diabetes, nerve entrapment, or another source–is the first step in receiving treatment. This all starts with an in-depth physical examination, where we can determine the level of neuropathy and whether or not other factors are involved. At Next Step Foot & Ankle Clinic, we use equipment such as a Sudomotor device that examines the level of sweat released by the sweat glands of the feet from an electrical impulse. We also utilize ultrasounds that can help us determine the nerve thickness and levels where dysfunction occurs. Once we know what we are up against, then rehabilitation can begin. We consider a range of treatments to alleviate neuropathy for each patient. Both surgical and non-surgical options are offered and oftentimes, Electrical Cell Signal (EST) therapy is a valuable tool to rehabilitate nerves to increase their density, blood flow, and ability to send signals. We explain in detail each treatment option to our patients, discuss the pros and cons, and decide together the best approach to take for that patient.
Early in my training it became evident that no one had an answer for neuropathy. I was always told as a resident that the patient needed to see their primary care doctor to get gabapentin and control their blood sugar. Controlling your blood sugar is absolutely essential to limit more damage but so is providing an environment within your body that allows your nerves to heal. It wasn’t until I met Dr. Silvester and became aware of the Association of Extremity Nerve Surgeons (AENS) that I realized that there is a great deal more that can be done to treat and alleviate neuropathy.
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