At Magdalena Blasko, DPM, Inc., we offer neuropathy treatment as one of our core services for close to 20 years in the San Francisco Bay Area. If you're ready to receive the level of care you deserve, call us at (415) 353-5715 or book online to the right. If not, read on to see how we can help! Hope to see you soon!
Neuropathy is a result of damage to the nerves that are not part of your brain or spinal cord. These nerves are known as peripheral nerves and fall into three categories: sensory, motor, and autonomic, and are all affected progressively as this disease worsens.
Causes: Neuropathy can result from metabolic conditions, traumatic injuries, certain bacterial and viral infection (Hepatitis, Lyme disease, shingles, HIV and leprosy), inherited disorders, autoimmune diseases and exposure to various toxins like lead. Other causes of neuropathy include alcoholism, vitamin deficiencies like Vit B12 and certain medications like cancer chemotherapy. Most common cause of neuropathy is diabetes. More than half of the diabetic population develop some form of neuropathy.
What are the symptoms of neuropathy?
The symptoms depend on the type of the affected nerves. They may be gradually onset and can spread upwards into your legs and hands in a glove and stocking distribution over time. When it comes to sensory nerves, you may feel a stabbing, tingling or burning pain in your feet. This is how neuropathy most commonly makes itself known.
You may have altered sensations of touch, temperature, pain and vibration. For example, when standing or with your feet under a blanket, you may feel unusual pain or tingling for no apparent reason. You may feel like you are wearing gloves or stockings when you are not.
If your motor nerves are involved, your muscle control will be reduced and you may experience an increased frequency of falls due to your weakened muscles. If your autonomic nerves are involved it will negatively affect your heart rate, blood pressure, bladder and digestion. Your heat tolerance may suffer and you may begin to sweat excessively, more frequently.
Usually neuropathy involves several peripheral nerves, therefore, you may develop various symptoms in concert together. Whatever the symptoms you may be experiencing, we will be able to help you. At Magdalena Blasko, DPM, Inc., our specialists are well trained and experienced to deal with any kind of foot problem you may have.
What are the complications of neuropathy?
If neuropathy is not identified and treated, complications can occur. The following list is not all inclusive, but represents the major issues that can arise.
Ulceration – Due to a lack of sensation, patients do not seek medical help in a timely manner. These wounds will develop under thickened nails and calluses and are dangerous because they can not be seen during daily checks, and the pain that normally accompanies wounds is not felt until the area becomes infected.
Infection – When one’s feet lack sensation, they can get injured without their knowledge. Infection can set in especially if you are diabetic. In diabetics the immune system is weakened, so patients do not develop the expected immune responses, like fever, pus, redness, or loss of appetite to fight the infections. In long-standing diabetic patients, the first signs of infection occur when the lymphnodes become tender. By this point, unfortunately, the bone is already infected and surgical intervention will most likely be necessary.
Burns – When one’s ability to sense temperature accurately is altered, they may inadvertently burn themselves. Common situations include warm water foot soaks accidentally being run as hot water foot soaks and chemical burns from over-application of callus removing agents.
Muscle atrophy – Motor nerve damage leads to aggressive aging and atrophication of the lower extremity muscles, creating all sorts of arthritic changes in the joints as well as inflammation of the tendons, ligaments and joint capsules. Patients will experience toe and foot pain, as well as ankle, knee and hip problems as a result of their skeletal frame becoming unaligned.
Falls – Muscle weakness and loss of sensation associated with lack of balance can be a reason for frequent falls, which can lead to possible hip and pelvic bone fractures and their associated complications.
Autonomic nerve damage – This can lead to skin problems like dryness, atrophy, poor circulation, and susceptibility to fungal and viral infections. Autonomic nerve damage also creates macular degeneration in the eye, kidney disease that may lead to dialysis, and widespread systemic effects on the body’s internal organs.
How do we diagnose neuropathy?
We will take a detailed medical history, a physical examination followed by a thorough neurological examination. Your tendon reflexes, muscle tone and strength will be checked along with an on-site testing of your body’s circulation. We may order certain blood tests to exclude diabetes, vitamin deficiencies, and autoimmune disorders. Imaging tests like CT or MRI scans will help us identify tumors or herniated disks which can lead to neuropathy.
Electromyography (EMG) is done to record electrical activity in your muscles to detect nerve damage. Nerve conduction studies are performed to record your nerves’ responses to electrical stimulation. Nerve biopsies are sometimes done to exclude nerve abnormalities while a skin biopsy from your feet can confirm a reduction in the amount of nerve endings.
How do we treat neuropathy?
Treatment goals include managing the condition causing your neuropathy and the relief of symptoms.
Pain relievers include Acetaminophen (Tylenol) and anti-inflammatory drugs such as Naproxen (Aleve) and Ibuprofen (Advil). For severe pain we can prescribe you a course of opioids such as tramadol or oxycodone. As they can cause dependence, they are used only if other treatments fail.
Antidepressants like Amitriptyline, Duloxetine (Cymbalta), Venlafaxine (Effexor XR) are found to be effective for managing neuropathic pain. We can also prescribe pregabalin (Lyrica) or Gabapentin (Neurontin). There are certain topical treatments like capsaicin cream and lidocaine which reduces pain by causing a burning sensation when applied. Lidocaine also comes in patches if we determine that this is the best course for you.
We can offer you various therapies and procedures to ease your symptoms such as TENS (Transcutaneous Electrical Nerve Stimulation), physical therapy when you suffer from muscle weakness and arthritic pain, and foot braces or inserts where necessary.
If your neuropathy is caused by a tumor exerting pressure on the nerves, we will most likely recommend surgery as the optimal method of treatment. Our office offers a comprehensive neuropathy management protocol over several weeks consisting of a combination of multiple procedures that will alleviate current symptoms as well as slow down the process of deterioration.
How can you prevent neuropathy?
The best way to prevent neuropathy is to manage conditions that put you at risk, such as diabetes, rheumatoid arthritis and alcoholism. We will educate you on healthy lifestyle choices that may not be readily apparent. Your diet must be rich in whole grains, lean protein, fruits and vegetables in order to keep your nerves healthy. We might also discuss food supplements if you are unable to get enough nutrients through your regular diet.
You will need to exercise regularly at least 30 minutes to one hour a day, 3-4 times a week to keep your nervous system active. We will guide you on how to avoid factors that lead to nerve damage, including repetitive motions, smoking, alcohol consumption, exposure to toxic chemicals and cramped position which put pressure on your nerves.
As with all medicine, early diagnosis is crucial to proper management. Once diagnosed, a minimum of yearly checks is recommended depending on the severity of your condition, strictly adhering to the doctor’s treatment instructions. This disease is easy to ignore because in most cases, neuropathy is pain-free. However, once it becomes symptomatic, control becomes much more difficult. It is imperative that once a loss of sensation is observed and neuropathy is diagnosed, conservative care such as regular nail and callus maintenance is performed by a medical professional to avoid the complications discussed.
Our staff at Magdalena Blasko, DPM, Inc. has been treating neuropathy for years so you can rest assured that you are in good hands. Stop in for a visit and we will be delighted to help you get the treatment you need.