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Diabetic Neuropathy and
Elements of the Foot Exam
Rosa Matonti RN, MSN, CDE, CNS
Diabetes Educator Patients Hospitalisés
Université de l'Hôpital du Nouveau-Mexique
États-Unis d'Amérique
Téléavertisseur 505-951-4352 505-925-6100 Bureau
rmatonti@salud.unm.edu
Hôpital Sacré-Coeur, Milot, Haïti
10 au 14 janvier 2011
Objectives
At the end of the presentation the
participant will be able to:
•  Define the risk factors associated with
diabetic neuropathy.
•  Define the classifications of diabetic
neuropathy.
•  Illustrate the treatment options for the
various classifications.
•  Complete a foot assessment.
Diabetic Neuropathy
•  About 60-70% of people with
diabetes have mild to severe
forms of nervous system damage,
including:
- Impaired sensation or pain in the feet
or hands
- Slowed digestion of food in the
stomach
- Carpal tunnel syndrome
- Other nerve problems
•  More than 60% of nontraumatic
lower-limb amputations in the
United States occur among people
with diabetes.
Risk Factors
•  Glucose control
•  Duration of diabetes
•  Damage to blood vessels
•  Mechanical injury to nerves
•  Autoimmune factors
•  Genetic susceptibility
•  Lifestyle factors
– Smoking
– Diet
Classification of Diabetic
Neuropathy
• Symmetric polyneuropathy
• Autonomic neuropathy
• Polyradiculopathy
• Mononeuropathy
Symmetric Polyneuropathy
•  Most common form of diabetic
neuropathy
•  Affects distal lower extremities and
hands (“stocking-glove” sensory
loss)
•  Symptoms/Signs
– Pain
– Paresthesia/dysesthesia
– Loss of vibratory sensation
Cell metabolism
Neuropathic ulcer on heel
Diagnostic Tests
•  Assess symptoms - muscle weakness,
muscle cramps, prickling, numbness or
pain
•  Comprehensive foot exam
– Skin sensation and skin integrity
– Quantitative Sensory Testing (QST)
– X-ray
•  Nerve conduction studies
•  Electromyographic examination (EMG)
Complications of Polyneuropathy
•  Ulcers
•  Charcot arthropathy
•  Dislocation and stress fractures
•  Amputation - Risk factors include:
– Peripheral neuropathy with loss of protective
sensation
– Altered biomechanics (with neuropathy)
– Evidence of increased pressure (callus)
– Peripheral vascular disease
– History of ulcers or amputation
– Severe nail pathology
Treatment of Symmetric
Polyneuropathy
• Glucose control
• Pain control
– Tricyclic antidepressants
– Topical creams
– Anticonvulsants
• Foot care
Essentials of Foot Care
•  Examination
– Annually for all patients
– Patients with neuropathy - visual inspection of
feet at every visit with a health care professional
•  Advise patients to:
– Use lotion to prevent dryness and cracking
– File calluses with a pumice stone
– Cut toenails weekly or as needed
– Always wear socks and well-fitting shoes
– Notify their health care provider immediately if
any foot problems occur
Treatment
•  Antidepressant drugs
–  amitriptyline 25-150 mg qhs
–  doxepin
– duloxetine
•  Antiseizure medications
–  gabapentin
–  pregabalin 50-100 mg tid (decrease in CKD
–  carbamazepine
– Valproate
Treatment
•  Caspsasin cream
•  Lidocaine cream
•  TENS unit (Transcutaneous Electrical Nerve
Stimulation)
•  Cannabinoids
Treatment of infections
•  Wound care
•  Anitbiotics
Polyradiculopathy
•  Lumbar polyradiculopathy (diabetic
amyotrophy)
– Thigh pain followed by muscle weakness
and atrophy
•  Thoracic polyradiculopathy
– Severe pain on one or both sides of the
abdomen, possibly in a band-like pattern
•  Diabetic neuropathic cachexia
– Polyradiculopathy + peripheral neuropathy
– Associated with weight loss and
depression
Polyradiculopathy, cont.
•  Polyradiculopathies are diagnosed
by electromyographic (EMG) studies
•  Treatment
– Foot care
– Glucose control
– Pain control
Mononeuropathy
•  Peripheral mononeuropathy
– Single nerve damage due to compression
or ischemia
– Occurs in wrist (carpal tunnel syndrome),
elbow, or foot (unilateral foot drop)
– Symptoms/Signs
• numbness
• edema
• pain
• prickling
•  Cranial mononeuropathy
– Affects the 12 pairs of nerves that are
connected with the brain and control sight,
eye movement, hearing, and taste
– Symptoms/Signs
• unilateral pain near the affected eye
• paralysis of the eye muscle
• double vision
•  Mononeuropathy multiplex
Mononeuropathy, cont.
Mononeuropathy, cont.
•  Treatment
– Foot care
– Glucose control
– Pain control
Neuropathy and Foot Exam - Diabetes Symposia

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Neuropathy and Foot Exam - Diabetes Symposia

  • 1. Diabetic Neuropathy and Elements of the Foot Exam Rosa Matonti RN, MSN, CDE, CNS Diabetes Educator Patients Hospitalisés Université de l'Hôpital du Nouveau-Mexique États-Unis d'Amérique Téléavertisseur 505-951-4352 505-925-6100 Bureau rmatonti@salud.unm.edu Hôpital Sacré-Coeur, Milot, Haïti 10 au 14 janvier 2011
  • 2. Objectives At the end of the presentation the participant will be able to: •  Define the risk factors associated with diabetic neuropathy. •  Define the classifications of diabetic neuropathy. •  Illustrate the treatment options for the various classifications. •  Complete a foot assessment.
  • 3. Diabetic Neuropathy •  About 60-70% of people with diabetes have mild to severe forms of nervous system damage, including: - Impaired sensation or pain in the feet or hands - Slowed digestion of food in the stomach - Carpal tunnel syndrome - Other nerve problems •  More than 60% of nontraumatic lower-limb amputations in the United States occur among people with diabetes.
  • 4. Risk Factors •  Glucose control •  Duration of diabetes •  Damage to blood vessels •  Mechanical injury to nerves •  Autoimmune factors •  Genetic susceptibility •  Lifestyle factors – Smoking – Diet
  • 5. Classification of Diabetic Neuropathy • Symmetric polyneuropathy • Autonomic neuropathy • Polyradiculopathy • Mononeuropathy
  • 6. Symmetric Polyneuropathy •  Most common form of diabetic neuropathy •  Affects distal lower extremities and hands (“stocking-glove” sensory loss) •  Symptoms/Signs – Pain – Paresthesia/dysesthesia – Loss of vibratory sensation
  • 7.
  • 9. Diagnostic Tests •  Assess symptoms - muscle weakness, muscle cramps, prickling, numbness or pain •  Comprehensive foot exam – Skin sensation and skin integrity – Quantitative Sensory Testing (QST) – X-ray •  Nerve conduction studies •  Electromyographic examination (EMG)
  • 10. Complications of Polyneuropathy •  Ulcers •  Charcot arthropathy •  Dislocation and stress fractures •  Amputation - Risk factors include: – Peripheral neuropathy with loss of protective sensation – Altered biomechanics (with neuropathy) – Evidence of increased pressure (callus) – Peripheral vascular disease – History of ulcers or amputation – Severe nail pathology
  • 11. Treatment of Symmetric Polyneuropathy • Glucose control • Pain control – Tricyclic antidepressants – Topical creams – Anticonvulsants • Foot care
  • 12. Essentials of Foot Care •  Examination – Annually for all patients – Patients with neuropathy - visual inspection of feet at every visit with a health care professional •  Advise patients to: – Use lotion to prevent dryness and cracking – File calluses with a pumice stone – Cut toenails weekly or as needed – Always wear socks and well-fitting shoes – Notify their health care provider immediately if any foot problems occur
  • 13. Treatment •  Antidepressant drugs –  amitriptyline 25-150 mg qhs –  doxepin – duloxetine •  Antiseizure medications –  gabapentin –  pregabalin 50-100 mg tid (decrease in CKD –  carbamazepine – Valproate
  • 14. Treatment •  Caspsasin cream •  Lidocaine cream •  TENS unit (Transcutaneous Electrical Nerve Stimulation) •  Cannabinoids
  • 15. Treatment of infections •  Wound care •  Anitbiotics
  • 16. Polyradiculopathy •  Lumbar polyradiculopathy (diabetic amyotrophy) – Thigh pain followed by muscle weakness and atrophy •  Thoracic polyradiculopathy – Severe pain on one or both sides of the abdomen, possibly in a band-like pattern •  Diabetic neuropathic cachexia – Polyradiculopathy + peripheral neuropathy – Associated with weight loss and depression
  • 17. Polyradiculopathy, cont. •  Polyradiculopathies are diagnosed by electromyographic (EMG) studies •  Treatment – Foot care – Glucose control – Pain control
  • 18. Mononeuropathy •  Peripheral mononeuropathy – Single nerve damage due to compression or ischemia – Occurs in wrist (carpal tunnel syndrome), elbow, or foot (unilateral foot drop) – Symptoms/Signs • numbness • edema • pain • prickling
  • 19. •  Cranial mononeuropathy – Affects the 12 pairs of nerves that are connected with the brain and control sight, eye movement, hearing, and taste – Symptoms/Signs • unilateral pain near the affected eye • paralysis of the eye muscle • double vision •  Mononeuropathy multiplex Mononeuropathy, cont.
  • 20. Mononeuropathy, cont. •  Treatment – Foot care – Glucose control – Pain control