Today's post from roundupweb.com (see link below) looks at the real dangers for some people living with diabetes and neuropathy, or just neuropathy on its own. Amongst these is the possibility of eventual amputation. Fortunately, the vast majority of people with neuropathy are never faced with losing toes, or feet but it can happen largely due to Peripheral Artery Disease. Simply put, this means that not enough blood reaches the extremities to keep the tissue alive and because severe lack of feeling and sensation can allow people to miss what's happening until it's too late, amputation is sometimes necessary. This article looks at why this happens but also gives some useful tips for all neuropathy patients regarding caring for their feet. Your doctor or specialist should be aware of the dangers but may need reminding that check-ups are sometimes necessary.
March 19, 2014 | Vol. 40 • No. 5
Some major, common complications of Diabetes Mellitus (DM) include coronary artery disease, peripheral artery disease, stroke, nephropathy, neuropathy, and retinopathy. Tragically many with diabetes or other circulation problems eventually require lower limb amputations. Those with DM should consider target goals that include HbA1c less than 7 data-blogger-escaped-70-130="" data-blogger-escaped-and="" data-blogger-escaped-before="" data-blogger-escaped-blood="" data-blogger-escaped-diastolic="" data-blogger-escaped-glucose="" data-blogger-escaped-meals.="" data-blogger-escaped-p="" data-blogger-escaped-pressure="" data-blogger-escaped-systolic=""more than Diabetic neuropathy affects 50% of people with Diabetes. Peripheral neuropathy is the damage to nerves that carry sensory and motor information to and from the brain to the arms and legs (often referred to as "stocking-glove"). This can cause pain, loss of sensation and weakness. Furthermore, peripheral neuropathy commonly starts in the hands and toes and progresses to the arms and legs. Common causes of peripheral neuropathy include diabetes, excessive alcohol, cancer, lupus, exposure to poisons and trauma.
The American Diabetes Association now recommends people with DM be screened annually for Peripheral Artery Disease (PAD). Less than 20% of people with PAD are diagnosed (most missed by not removing shoes during an exam). PAD undiagnosed becomes critical limb ischemia- not enough blood is delivered to the tissue to keep tissue alive. Within one year of onset of this critical limb ischemia 25% will die and 25% will require major amputation. It's best diagnosed using Doppler.
Other risk factors for lower limb amputation include:
• Absence of protective sensation due to peripheral neuropathy (Monofilament testing),
• Arterial insufficiency
• Foot deformity and callus formation resulting in focal areas of high pressure
• Autonomic neuropathy causing decreased sweating and dry, fissured skin.
• Limited joint mobility
• Obesity
• Impaired vision
• Poor glucose control leading to impaired wound healing
• Poor footwear that causes skin breakdown or inadequately protects the skin from high pressure and shear forces
• History of foot ulcer or lower extremity amputation
Up to 30 % of individuals with amputations undergo contralateral limb amputation within 1-3 years. Education and taking preventative measures is imperative!
What is LEAP?
LEAP stands for Lower Extremity Amputation Prevention. It's a comprehensive program that can dramatically reduce the risk for lower extremity amputations for those with Diabetes. The 5-Step program consists of Annual Foot Screening, Patient Education, Daily Self-Inspection, Footwear Selection, and Management of Simple Foot Problems.
Do you know about Monofilament and Vibratory screening?
Examination is key! Annual foot screening as mentioned above is a prevention screening to identify those who have lost protective sensation. With loss of protective sensation normal walking can result in such injuries. One method for examination for peripheral neuropathy is checking vibratory sense and monofilament. Inability to perceive the 128-Hz tuning fork or to feel a 10-g (5.07) monofilament on the bottom of the foot identifies people who are at increased risk of developing a foot ulcer, which is the leading cause for non-traumatic amputations leading to a 40-60% risk for 5-year mortality. The 2 tests should be performed at least every year.
Are there others things to consider?
Foot Care! Have your feet checked EVERY TIME you see your doctor.
• Check your feet everyday, top and bottom (use a mirror), and you many need help- let someone else look. Look between your toes. Look for cuts, blisters, sores, swelling, dry skin, cracks. Call your doctor to report a problem.
• Corn and Callous care- rub gently with dry towel, NO corn plasters. If you have corn or callous buildup, go to the foot specialist to get them trimmed.
• Nail care- cut toenails straight across, smooth edges with emery board. NO scissors, knife or razor blades!
• Skin care- Check water temperature, wash feet everyday and pat dry with a towel. Dry between toes. Treat dry skin with an appropriate lotion, warm cold feet and NO heating pad or hot water soaking.
• Shoe selection- ALWAYS check inside of shoes before wearing them. Wear clean socks with no holes, seams, wrinkles or mendings. NO plastic flip-flops, pointy toed shoes or barefoot. Shoes that fit protect your feet: There should be a thumbs width between the end of the shoes and the end of the toe. Make sure someone measures your foot for you (don't rely on how the shoe "feels"). You may ask the health care professional to check your shoes before you wear them.
For more information you can go online http://www.hrsa.gov/leap/.
http://www.roundupweb.com/story/2014/03/19/special-editions/do-you-know-some-of-these-serious-risks-that-can-be-related-to-diabetes-pad-and-peripheral-neuropathy/4329.html
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