Peripheral neuropathy is the most common systemic complication of diabetes, affecting up to 25% of all diabetics (132 million people worldwide). Diabetic neuropathy is implicated in upwards of 75% of non-traumatic amputations yearly.
Peripheral neuropathy is thought to be caused by damage to nerves and their blood supply and lead to a lack of protective sensation. This puts the individual at risk suffering an injury and it going unnoticed.
Peripheral neuropathy can also affect the motor nerves, often presenting as difficulty with fine motor activities; or even disrupt autonomic nervous system function and interfere with things like bowel movements and blood pressure.
Peripheral neuropathy can also be caused by a number of health problems and interventions: vitamin deficiency, chemotherapy and radiation, alcohol abuse, peripheral vascular disease, spinal tumours and even simple pressure on a nerve.
In short, we need to look after these little nerve fibres, because without them the body doesn’t know what is happening around it. And if you don’t know what is going on, you can’t react appropriately.
Podiatrists currently play a key role in the screening for peripheral neuropathy and the management particularly of skin concerns which result from it. The nerves furthest from the spinal cord are often the first affected, meaning the feet and lower limbs are the first symptomatic presentation of neuropathy in most cases.
Podiatrists are able to perform foot and vascular assessments which can be used to determine the appropriate treatment for peripheral neuropathy. These involve a thorough assessment of the feet including, but not limited to, the following:
- Palpation and doppler assessment of pulses
- Examination of venous function
- ABPI (Ankle Brachial Pressure Index)
- Perfusion and skin assessment
- Sensation testing, including vibration perception and monofilament.
These assessments are helpful in the prescription of compression therapies and are key to monitoring disease progression.