The Pain of Diabetes
March 23, 2008
Diabetes is one of the most common reasons people seek relief for painful feet. In diabetes, four types of problems may arise in the feet as part of the disease process.
Nerve Problems due to Diabetes
The most common contributor to foot pain in diabetes is a nerve problem called Peripheral Neuropathy . This is where the nerves are directly affected by the disease process. There are basically three types of peripheral neuropathy: sensory neuropathy, motor neuropathy, and autonomic neuropathy.
A large percentage of pain that diabetic patients complain of is due to sensory neuropathy. This can show up as “sensitive pain,” where the amount of pain is not proportional to the amount of insult that is causing it. For instance, just touching the skin or putting a sheet over your feet in bed could be painful. This can be present at the same time as numbness in the feet. Relief is first and foremost on someone’s mind when a foot can be numb and excruciatingly painful at the same time. Sensory neuropathy symptoms can include burning, tingling or a stabbing pain.
Motor neuropathy can contribute to a painful condition in the diabetic person. In motor neuropathy, the nerves to the muscles become affected by the disease process. This makes the muscles feel weak and achy. Some of the first muscles to become affected are those in the thigh. Other common muscles include the shin muscle and the small muscles of the feet. When motor neuropathy is present, walking imbalances can result. These imbalances can occur from increased rubbing of the foot in the shoe, inflammation of the skin, increased callous formation, and pain.
Autonomic neuropathy affects the nerves to areas that are not under our conscious control. The most common way that autonomic neuropathy causes symptoms in the foot is through the sweating mechanism. This is altered and therefore the person who suffers with this condition may have thickened dry cuticles and nails; as well as dry, stiff, cracked skin which is subject to a buildup of thicker calluses with more pain. Bacterial and fungal infection could be more likely; and an additional source of pain and concern.
Daily use of a conditioning foot cream made for diabetic foot care and toenail oil plays an essential role in preventing these problems from occurring.
Circulation Problems
Circulation problems in the feet may cause intense pain, even though the feet may feel numb. This is due to the effect of the diabetes on the arteries, capillaries and veins. Arteries feed fresh blood away from the heart. This fresh blood nourishes and provides oxygen to the tissues. The blood enters and leaves the tissues through capillaries and goes back up to the heart to get refreshed with oxygen and nourishment by way of the veins.
The arteries most commonly affected are those behind the knee and the calf. These arteries are subject to the same fatty deposits that most people have, however, the process can be accelerated in diabetes. These fatty deposits thicken the walls of the arteries and may develop calcium deposits. Blood flow to the tissues could then be partially or totally blocked. Because the tissues are starving for oxygen, this can be an extremely painful process. Often the pain is described as though their feet are in a vice and being strangled.
The capillaries are known to get thickened and stiff in diabetes. Because of this they are not as efficient in delivering the oxygen and nutrients to and from the tissues.
The veins can get swollen and painful. This happens when the arteries cannot handle the blood flow, and little channels are created to direct the blood over to the veins instead of trying to push the blood through closed arteries. Sometimes there is more blood than the veins can handle and they become so full that the valves that push the blood back to the heart become broken. Blood then “pools” in the feet and legs and can leak out into the skin, creating ulcerations, which can be very painful.
With the approval of your medical doctor, support hose, exercise, massage, physical therapy modalities, medications and various surgical procedures can be used to improve the circulation.
Muscle & Joint Problems
Muscle and joint problems in the diabetic patient are a frequent source of discomfort and pain.
The muscles are affected by diabetic neuropathy, circulation problems and atrophy. The tendons (attachment of the muscle to the bones) may become stiff and contracted due to the walking imbalance associated with peripheral neuropathy.
This walking imbalance forces the foot and joints to move in ways that are not healthy and that Mother Nature never intended. In addition, they may stiffen in this bent position because of the excess blood sugar combining with the proteins in the joints. This is called “diabetic glycosylation of the joints.”
This, combined with the normal imbalance all people, including non-diabetics, are subject to, can lead to stiff hammertoes, bunions, spurs, and tiny fractures with dislocation of the bones (called Diabetic Charcot Deformity). These problems can be a source of pain, infection, ulceration and major medical concern.
With consent from your foot healthcare provider, foot rollers, massage and specially made shoes and inserts might be the best way to deal with these muscle and joint problems.
Frequent Infections
Diabetic persons become more susceptible to bacterial, fungal and yeast infections due to medical and nutritional changes that takes place in the body.
Bacterial infections show up in areas on the foot that become irritated, ulcerated or injured. The signs of a bacterial infection include redness, swelling, warmth, pain and tenderness as well as the presence of pus. This kind of infection can either be on the skin, called “Cellulitis,” or can spread to the bone. When infection has spread to the bone it is called “Osteomyelitis.” It is interesting that even though a diabetic may have numbness in their foot, they could sometimes feel pain when they have a bacterial infection. When a diabetic suddenly develops pain while their feet are still numb, it could be a sign that an infection is present and a health care provider should be contacted without delay.
Fungal or yeast infections in the foot commonly occur as “Athlete’s Feet” or “Fungal Toenails.” Athlete’s feet can cause the skin to become blistered, scaly, red, inflamed and painful. A bacterial infection can occur on top of this because the irritated skin serves as a good place for germs to thrive. Fungal toenails can become very thick, powdery and ingrown. These thick nails can leave debris under the nails and cause severe irritation to the skin surrounding the nails. They can even become ingrown with callused nail grooves. This can cause infection to the areas surrounding the nail and is a source for medical concern. Thick fungal and ingrown toenails can cause the skin on the sides of the nails to become overgrown, cystic and very painful. They can also exert pressure on the skin under the nail, which can cause irritation, pain and infection.
To help prevent these infections, it is important to control blood sugar and provide proper maintenance of the skin and nails. Self inspection every day is a must!
It is important to note that not all diabetics can feel these problems as painful and therefore should have their feet visually and manually inspected every day.
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I would like info. on how to contact Dr. Rehm. I would like to interview him for an article I am writing on diabetic foot ulcers.