Peripheral Neuropathy

It is characterized by a gradual loss of protective sensation in the feet, legs and, sometimes, arms and hands. Perception of touch, pressure, temperature, and pain are affected. It’s important because it is the most significant predictor of foot ulceration and other complications in the diabetic population. The lack of painful feedback makes it easy for unnoticed repetitive trauma to occur to the feet. Now, let’s look at the three main types of neuropathy: sensory, motor, and autonomic.

Sensory neuropathy is the loss of sensation, specifically, inability to feel pressure and pain caused by outside forces, as well as altered proprioception: inability to know the position of the feet. Since sensory nerves send messages from the muscles to the spinal cord and the brain, when these nerves cease to function, the message or impulse about sensation does not get sent. The result is extreme sensitivity to touch, numbness, tingling, and pain. Loss of protective sensation can lead to repeated injuries, including burns and abrasions, as well as mechanical stress.

Motor neuropathy often leads to foot deformities which further predispose a diabetic foot to ulceration. Some common deformities include: contracted toes, hammer and claw toes, limited joint mobility, prominent metatarsal heads, as well as weakness and deformity of the small muscles of the foot. It’s the function of the motor nerves to send impulses from the brain and spinal cord to all the muscles in the body. When these nerves are damaged the result is muscles spasms, cramps and weakness, as well as difficulty moving and walking.

Autonomic neuropathy leads to no oil or sweat being produced by the skin due to autonomic system dysfunction. Autonomic system is involuntary. It presides over such bodily functions as blood pressure, heart rate, sweating, and digestion. When the skin can no longer produce sweat or oil it becomes dry, non-elastic, and hot to touch, which can lead to cracking, wound formation, and, possibly, infection.

All clients with diabetes but without neuropathy are considered to be at high risk of developing neuropathy. It is essential for them to examine their feet every day looking for abnormalities, sores, and abrasions, check footwear for foreign objects, avoid going barefoot, check water temperature before getting into shower or bath, wear wide shoes with good insoles and big toe box, and tell their doctor if they have any issues with their feet.

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