Peripheral Neuropathy: The Prevention and Care of Sores on the Feet

Dry gangrenePeripheral neuropathy is the term for damage to nerves that carry messages to and from the brain and spinal cord, usually to the hands and feet. It can cause weakness, numbness, and pain or lack of it. Three to four percent of people over the age of 55 are affected. Neuropathy is most common in people with diabetes, but it can also be the result of traumatic injuries, infections, metabolic problems, autoimmune or other diseases, exposure to toxins or some medications. As many as one-third of all neuropathies are from an unknown cause, and are classified as idiopathic.
Signs and symptoms of peripheral neuropathy might include:1

  • Gradual onset of numbness, prickling or tingling in your feet or hands
  • Sharp, jabbing, throbbing or burning pain
  • Extreme sensitivity to touch
  • Pain during activities that shouldn’t cause pain, such as pain in your feet when putting weight on them or when they’re under a blanket
  • Muscle weakness; lack of coordination and falling
  • Feeling as if you’re wearing gloves or socks when you’re not

Seek medical care right away if you or a loved one notices unusual tingling, weakness or pain in the hands or feet. Early diagnosis and treatment offer the best chance for controlling symptoms and preventing further damage to peripheral nerves.
Complications
People with chronic neuropathy often lose the ability to feel temperature and pain. They can burn themselves or develop open sores that are the result of pressure and friction, as from an ill-fitting shoe. Feet and other areas lacking sensation can become injured without the person knowing it. For example, without pain to signal there’s a problem, people with neuropathy can allow small abrasions or blisters on their feet to become sores or ulcers. An open wound can become infected, which can lead to an infection in a bone. If the infection progresses to that point, it will probably require an amputation. Poor circulation in the foot and nerve damage also make the healing of a wound a slower process. 
Example
My husband has had idiopathic peripheral neuropathy for several years. I wrote about its effect on his failed bunion surgery in another Dakota Home Care blog. Unfortunately that toe is now gone. It had to be amputated because a blister caused by unnoticed rubbing inside his shoe very quickly turned into an infected ulcer and then dry gangrene. [Photo above is an example of dry gangrene.] One article I read said this could happen “overnight.” Even with antibiotics and weekly visits to his podiatrist, the sore failed to heal completely. We were told that poor circulation in the feet makes that not-so-unusual.
Finally, the Dr. ordered an MRI, and it was discovered that the infection (osteomyelitis2) had spread to the bone of his big toe. Antibiotics can rarely help to cure this type of infection. Amputation at the lower joint was his only option. (Yes, we got a second opinion.) To ensure that the wound caused by the amputation would heal, he had to stay off of it and keep that foot elevated for three weeks. His neuropathy had done so much damage to the nerves in that toe that he required no pain medication after the amputation. He couldn’t feel what would have cause most of us a great deal of pain. When his incision had finally healed, PT was prescribed to reteach walking in the correct way for balance and strength building.
paper published in The New England Journal of Medicine estimated that “between 19 and 34 percent of people with diabetes will struggle with at least one foot ulcer in their lifetime. This can become a chronic problem, with two out of five people experiencing another ulcer within the next year, and the consequences can be devastating: About 20 percent of patients with a moderate to severe infection will end up with an amputation.” Any type of neuropathy has a similar risk. It can also make feet weaker and change their shape, decreasing the ability to balance and increasing the risk of injury.
Prevention
The best way to prevent peripheral neuropathy is to manage medical conditions that put one at risk, such as diabetes, alcoholism or rheumatoid arthritis. Of course, in cases of idiopathic neuropathy where no cause is known, prevention is not possible. If a loved one has neuropathy or could develop it from diabetes, look at their feet morning and night for any signs of irritation or pressure. Ask for a foot check every time you see a primary care provider. Choose footwear carefully with the help of a podiatrist. Be sure they wear their shoes constantly to protect their feet. Even a bed slipper can cause a sore, if it has a seam in the wrong place or doesn’t fit properly. After his bunion surgery, my husband developed a sore around the base of his big toe from just the ACE bandage the Dr. had placed there to hold his toe in position. See a Dr. as soon as a foot sore develops.
At Dakota Home Care, we work with the patient, family and home care staff to draft and implement an individualized plan of care. Checking regularly for foot irritations, blisters or sores and participating in the prescribed care required for healing can be a part of your loved one’s care plan carried out by a member of our staff.  Call us today at (701) 663-5373 to schedule an in-home evaluation. A registered nurse will determine what we can do to help keep home an option for someone in your family.
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