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Numb, Painful or Burning Feet?

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Numb, Painful or Burning Feet?

Numbness, pain or burning are warning signals from our nerves that something is wrong. The goal of treatment is to find out what is wrong and to fix it, not to just mask or cover up the warning signs. View this presentation to learn more.

Numbness, pain or burning are warning signals from our nerves that something is wrong. The goal of treatment is to find out what is wrong and to fix it, not to just mask or cover up the warning signs. View this presentation to learn more.

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Numb, Painful or Burning Feet?

  1. 1. Peripheral Neuropathy A Critical Look/Fact or Fiction
  2. 2. What exactly is “neuropathy”? (nerve cell)
  3. 3. Neuropathy is: the progressive loss of nerve fiber function.
  4. 4. Diabetic peripheral neuropathy has been defined as: “The presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after the exclusion of other causes.” Boulton, AJ, et. al, Diabetic Neuropathy. Med Clin North America, Jul 1998:82(4): 909-929.
  5. 5. Unfortunately, no one pays much attention to the last and most important part of that definition “after the exclusion of other causes.”
  6. 6. Fact: Peripheral neuropathies are the most common complication of diabetes mellitus (DM).
  7. 7. It is believed that up to 50% of both Type I and Type II diabetics are affected.
  8. 8. If diabetes was the main etiology for peripheral neuropathy then shouldn’t all diabetics eventually end up with neuropathy?
  9. 9. Type I diabetics are potentially affected with this nerve condition after decades of chronic uncontrolled blood sugar levels while Type II diabetics can have signs/symptoms of neuropathy after only a few years of diagnosis. Strange Fact: (Seems like it would be the other way around?)
  10. 10. Type I diabetics don’t develop signs/symptoms of peripheral neuropathy until they are in their 40s/50s. Average age of diagnosis of Type I DM is 14 years old.
  11. 11. Type II diabetics aren’t diagnosed until they are middle aged or older. 50 years old and older. Unfortunately, that number is getting younger due to increase in type II pediatric diabetes.
  12. 12. No one can refute the fact that the loss of sensation on the bottom of the foot is not a good thing.
  13. 13. It leads to all sorts of problems.
  14. 14. And it’s more complicated then just the loss of feeling.
  15. 15. There is also painful neuropathy.
  16. 16. Neuropathy severely affects the quality of one’s life.
  17. 17. Besides living with severe pain
  18. 18. There are secondary effects including • Foot ulcers- – Typical cost to heal a foot ulcer- $8,000 – Typical cost to heal an infected ulcer-$17,000 • Falls • Fractures
  19. 19. But the worst thing is:
  20. 20. Amputation
  21. 21. It is estimated that someone loses a leg every 18 minutes as an ultimate complication from neuropathy. Average cost for a below-knee amputation (BKA) is $45,000 There are 80,000 BKA performed/year Usually the opposite limb develops an ulcer within 18 months 58% go on to have a BKA of the residual limb within 3-5 years.
  22. 22. Anything and everything needs to be done to combat this progressive nerve disorder.
  23. 23. The unfortunate fact is that once a patient presents to a doctor with nerve symptoms the first thought the doctor has is:
  24. 24. DIABETIC NEUROPATHY!
  25. 25. At that point the case is closed.
  26. 26. “Sorry, we can’t do much for you.”
  27. 27. It will only get worse.
  28. 28. Sure, you can try to keep your blood sugar under control.
  29. 29. You can take vitamin supplements and wear cushioned shoes.
  30. 30. Keep coming back for check- ups so that we can monitor how bad it is getting.
  31. 31. If you develop painful neuropathy we will offer you pills to mask the pain. Have you ever taken a look at the possible side-effects of those pills? You might be surprised.
  32. 32. Don’t worry I am going somewhere with this.
  33. 33. What is it about diabetes that leads to the destruction of nerves in the feet and hands?
  34. 34. The fact is- we really don’t know.
  35. 35. There is quite a bit of confusion as to why and there are several theories. Only thing is that none of them have really been proven.
  36. 36. DM peripheral neuropathy is blamed on: • Long-term high blood sugar levels • High cholesterol • High blood pressure • Smoking • Increased height (taller than normal?) • High exposure to ethanol • Genetic factors
  37. 37. Diabetes isn’t the only disease that affects the peripheral nerves.
  38. 38. There are several other forms of neuropathy including: • Alcohol consumption • Chemotherapeutic medicine • COMPRESSION of the nerve • Familiar (parent/grandparent) • Idiopathic (can’t figure out why, can’t blame it on anything else)
  39. 39. Besides the co-finding that you also have a family history of neuropathy, have been diagnosed as being “pre-diabetic”, Type I or II diabetic, had chemotherapy, excessive amount of alcohol consumption for to many years, or we don’t know why you have it…
  40. 40. … are there different findings as far as the signs or symptoms of neuropathy?
  41. 41. In other words, there is not one symptom or finding that links the cause of nerve damage to diabetes, genetic, alcoholism, kn own or unknown reason.
  42. 42. What I mean is that we don’t say “oh you have diabetic neuropathy because you have pain or loss of feeling in your big toe” or “if you have pain or loss of feeling in your little toe it is related specifically to chemotherapy”.
  43. 43. Peripheral nerve facts • Nerves outside of the spine are capable of repairing themselves when damaged. • Nerves are able to withstand up to a 6% strain without being affected. • Nerves can be slightly flattened without long- term damage.
  44. 44. What about nerves that are constantly being over-stretched while at the same time being flattened and compressed?
  45. 45. And this happens- day after day, week after week, month after month, year after year.
  46. 46. Another fact: Overwhelming majority of individuals suffering with peripheral neuropathy are over 40 years of age.
  47. 47. The majority are over 50 years of age.
  48. 48. Let’s shift our focus to dysfunction of nerves on the bottom of the foot.
  49. 49. Walking is the second most common conscious function of our body.
  50. 50. Average person takes 6,000 steps a day 42,000 steps a week 168,000 steps a month 2,016,000 steps a year 40,320,000 steps in 20 yrs 80,640,000 steps in 40 yrs 120,960,000 steps in 60 yrs
  51. 51. Remember earlier we learned that most diabetics (either Type I or Type II) don’t develop peripheral neuropathy signs/symptoms until they are 40 years old or older. Anyone 40 years old has on average taken over 80,000,000 steps.
  52. 52. Did you know there is one main nerve collecting all of the sensations from the bottom of the foot? Tibialis posterior nerve
  53. 53. All of the nerves from the bottom of the foot travel toward the spine from behind the inner ankle bone. Tibialis posterior nerve
  54. 54. The exact area where the nerves from the bottom of the foot travel to the ankle area is a very potentially dangerous area.
  55. 55. There are 2 tissue tunnels where the nerves transition from horizontal to vertical orientation.
  56. 56. There is a reason why I am pointing this out- keep going.
  57. 57. Hindfoot alignment is very important for many things but especially when it comes to these 2 tunnels.
  58. 58. When the ankle bone (talus) dislocates (partially) on the heel bone (calcaneus) this has a dramatic and very bad effect to the nerves within those two tunnels.
  59. 59. The partial dislocation of the ankle bone on the heel bone has been scientifically shown to: cause pathologic over-stretching of the nerve(s) & abnormally increases the pressures within the tunnels The Effect of HyProCure Sinus Tarsi Stent on Tarsal Tunnel and Porta Pedis Pressures. Journal of Foot and Ankle Surgery, Volume 50, (1) Pages 44-49, January 2011 Effect of Extra-Osseous TaloTarsal Stabilization on Posterior Tibial Nerve Strain in Hyperpronating Feet: A Cadaveric Evaluation Journal of Foot and Ankle Surgery, Volume 50, (6), Pages 672- 675, November 2011
  60. 60. A mis-aligned hindfoot leads to constant compression and overstretching of the nerves while standing.
  61. 61. And a mis-aligned hindfoot leads to intermittent damage with every step taken.
  62. 62. Walking is supposed to be so good for you. That is, unless you have mis-aligned feet! There are hidden dangers of walking!
  63. 63. Many people with peripheral neuropathy will tell you that the symptoms aren’t so bad or even non- existent when they first get out of bed in the morning …
  64. 64. …but the longer they are on their feet then the symptoms get worse.
  65. 65. WHY? Because when they were laying down and off their feet the nerve was not being overstretched nor compressed. Upon weightbearing the nerves were being crushed and over-stretched.
  66. 66. Other individuals with painful neuropathy at night have often gotten out of bed and started walking round and round until finally the pain in their feet went away.
  67. 67. The reason why the pain was worse after they had been off their feet was that the nerves were “waking up” and walking around made them go “back to sleep”.
  68. 68. There is a strong correlation between foot neuropathy and faulty foot mechanics.
  69. 69. The problem with only releasing any entrapped nerves is that nothing is usually done to realign the foot.
  70. 70. Arch supports may be beneficial, but for many patients these devices just end up pushing on the nerves and make their symptoms worse.
  71. 71. A somewhat new and more importantly, scientifically proven internal option now exists.
  72. 72. HyProCure® Extra-osseous, extra- articular, talotarsal fixation device.
  73. 73. Did you know…
  74. 74. HyProCure® has been used safely and effectively in thousands of pediatric and adult patients since 2004. Stabilization of Joint Forces of the Subtalar Complex via the HyProCure Sinus Tarsi Stent Journal of American Podiatric Medical Association, Volume 101 No. 5, Pages 390-399, Sept/Oct 2011 Extra-Osseous Talotarsal Stabilization using HyProCure in Adults: A 5 Year Retrospective Follow-up Journal of Foot and Ankle Surgery – Vol. 51 (1), p. 23-29, 2012
  75. 75. HyProCure® is the only extra-osseous talotarsal stabilization device that works with the normal mechanics unlike other devices that work against the normal function and often leading to failure of the device. + =
  76. 76. HyProCure® is the only medical treatment that has been scientifically proven to decrease the pressures within the tarsal tunnel and porta pedis while at the same time decreasing the strain on the nerve. The Effect of HyProCure Sinus Tarsi Stent on Tarsal Tunnel and Porta Pedis Pressures. Journal of Foot and Ankle Surgery, Volume 50, (1) Pages 44-49, January 2011 Effect of Extra-Osseous TaloTarsal Stabilization on Posterior Tibial Nerve Strain in Hyperpronating Feet: A Cadaveric Evaluation Journal of Foot and Ankle Surgery, Volume 50, (6), Pages 672-675, November 2011
  77. 77. Every effort must be considered to eliminate any factor that could lead to the destruction of peripheral nerves.
  78. 78. Generally speaking, the medical establishment has always been against any surgical option.
  79. 79. We have followed their advice of: early detection frequent physician visits strict diabetic control but the disease still remains and often gets worse.
  80. 80. The need for early surgical intervention is important. While standing, walking, or running the nerves to the bottom of the foot are being destroyed.
  81. 81. Eventually, the critical threshold is reached where there is no chance of the nerve to heal itself.
  82. 82. While we can’t ignore the fact that high blood sugar, excessive alcohol consumption, and the other potential causes must be controlled or eliminated, we cannot ignore the simple facts of the trauma inflicted on the nerve as a result of the faulty foot alignment.
  83. 83. The risk benefit analysis of the HyProCure® option shows that the benefits are far greater then any potential risks.
  84. 84. Let’s do all that we can to make a difference

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