Numb, Painful or Burning Feet?

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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 NeuropathyA Critical Look/Fact or Fiction
  2. 2. What exactly is “neuropathy”?(nerve cell)
  3. 3. Neuropathy is:the progressive lossof nerve fiber function.
  4. 4. Diabetic peripheral neuropathyhas been defined as:“The presence of symptoms and/or signs ofperipheral nerve dysfunction in people withdiabetes 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 muchattention to the last and mostimportant part of that definition“after the exclusion of other causes.”
  6. 6. Fact:Peripheral neuropathies are the most commoncomplication of diabetes mellitus (DM).
  7. 7. It is believed that up to 50% of bothType I and Type II diabetics areaffected.
  8. 8. If diabetes was the main etiology for peripheralneuropathy then shouldn’t all diabeticseventually end up with neuropathy?
  9. 9. Type I diabetics are potentially affected with this nervecondition after decades of chronic uncontrolled blood sugarlevelswhileType II diabetics can have signs/symptoms ofneuropathy 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 developsigns/symptoms of peripheralneuropathy until they are in their40s/50s.Average age of diagnosis of Type I DM is 14 years old.
  11. 11. Type II diabetics aren’t diagnoseduntil 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 theloss of sensation on the bottom ofthe foot is not a good thing.
  13. 13. It leads to all sorts of problems.
  14. 14. And it’s more complicated thenjust the loss of feeling.
  15. 15. There is also painful neuropathy.
  16. 16. Neuropathy severely affects thequality 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 aleg every 18 minutes as an ultimatecomplication from neuropathy.Average cost for a below-knee amputation (BKA) is $45,000There are 80,000 BKA performed/yearUsually the opposite limb develops an ulcer within 18 months58% go on to have a BKA of the residual limb within 3-5 years.
  22. 22. Anything and everything needs tobe done to combat thisprogressive nerve disorder.
  23. 23. The unfortunatefact is that once apatient presentsto a doctor withnerve symptomsthe first thoughtthe doctor hasis:
  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 keepyour blood sugar undercontrol.
  29. 29. You can take vitaminsupplements and wearcushioned shoes.
  30. 30. Keep coming back for check-ups so that we can monitorhow bad it is getting.
  31. 31. If you develop painfulneuropathy we will offeryou pills to mask the pain.Have you ever taken a look at the possibleside-effects of those pills?You might be surprised.
  32. 32. Don’t worry I am goingsomewhere with this.
  33. 33. What is it about diabetes that leadsto the destruction of nerves in thefeet and hands?
  34. 34. The fact is- we really don’t know.
  35. 35. There is quite a bit of confusion asto why and there are severaltheories.Only thing is that none of them havereally been proven.
  36. 36. DM peripheral neuropathyis 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 thataffects the peripheral nerves.
  38. 38. There are several other forms ofneuropathy including:• Alcohol consumption• Chemotherapeutic medicine• COMPRESSION of the nerve• Familiar (parent/grandparent)• Idiopathic (can’t figure out why, can’t blame it on anythingelse)
  39. 39. Besides the co-finding that you alsohave a family history ofneuropathy, have been diagnosed asbeing “pre-diabetic”, Type I or IIdiabetic, hadchemotherapy, excessive amount ofalcohol consumption for to manyyears, or we don’t know why youhave it…
  40. 40. … are there different findings as faras the signs or symptoms ofneuropathy?
  41. 41. In other words, there isnot one symptom or findingthat links the cause of nervedamage todiabetes, genetic, alcoholism, known or unknown reason.
  42. 42. What I mean is that we don’t say“oh you have diabetic neuropathybecause you have pain or loss offeeling in your big toe” or “if youhave pain or loss of feeling in yourlittle toe it is related specifically tochemotherapy”.
  43. 43. Peripheral nerve facts• Nerves outside of the spine are capable ofrepairing themselves when damaged.• Nerves are able to withstand up to a 6% strainwithout being affected.• Nerves can be slightly flattened without long-term damage.
  44. 44. What about nerves that are constantlybeing over-stretched while at the sametime 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 ofindividuals suffering with peripheral neuropathyare over 40 years of age.
  47. 47. The majority are over 50 years of age.
  48. 48. Let’s shift our focus to dysfunctionof nerves on the bottom of the foot.
  49. 49. Walking is the secondmost commonconscious function ofour body.
  50. 50. Average person takes6,000 steps a day42,000 steps a week168,000 steps a month2,016,000 steps a year40,320,000 steps in 20 yrs80,640,000 steps in 40 yrs120,960,000 steps in 60 yrs
  51. 51. Remember earlier we learned thatmost diabetics (either Type I or TypeII) don’t develop peripheralneuropathy signs/symptoms untilthey are 40 years old or older.Anyone 40 years old has on averagetaken over 80,000,000 steps.
  52. 52. Did you know there isone main nervecollecting all of thesensations from thebottom of the foot?Tibialis posterior nerve
  53. 53. All of the nervesfrom the bottomof the foot traveltoward the spinefrom behind theinner anklebone.Tibialis posterior nerve
  54. 54. The exact areawhere the nervesfrom the bottomof the foot travelto the ankle areais a verypotentiallydangerous area.
  55. 55. There are 2 tissuetunnels where thenerves transitionfrom horizontal tovertical orientation.
  56. 56. There is a reason why I ampointing this out- keep going.
  57. 57. Hindfoot alignment is very importantfor many things but especially when itcomes to these 2 tunnels.
  58. 58. When the ankle bone (talus)dislocates (partially) on the heelbone (calcaneus) this has a dramaticand very bad effect to the nerveswithin those two tunnels.
  59. 59. The partial dislocation of the ankle bone on the heelbone has been scientifically shown to:cause pathologic over-stretching of the nerve(s)&abnormally increases the pressures within the tunnelsThe Effect of HyProCure Sinus Tarsi Stent onTarsal Tunnel and Porta Pedis Pressures.Journal of Foot and Ankle Surgery, Volume 50, (1) Pages 44-49,January 2011Effect of Extra-Osseous TaloTarsal Stabilization onPosterior Tibial Nerve Strain in HyperpronatingFeet: A Cadaveric EvaluationJournal of Foot and Ankle Surgery, Volume 50, (6), Pages 672-675, November 2011
  60. 60. A mis-aligned hindfoot leads toconstant compressionandoverstretching of the nerveswhile standing.
  61. 61. And a mis-aligned hindfoot leads tointermittent damagewith every step taken.
  62. 62. Walking is supposed to be so goodfor you. That is, unless you havemis-aligned feet!There are hidden dangersof walking!
  63. 63. Many people with peripheralneuropathy will tell you that thesymptoms aren’t so bad or even non-existent when they first get out of bed inthe morning …
  64. 64. …but the longer they are on theirfeet then the symptoms get worse.
  65. 65. WHY?Because when they were laying down and offtheir feet the nerve was not beingoverstretched nor compressed.Upon weightbearing the nerves were beingcrushed and over-stretched.
  66. 66. Other individuals with painful neuropathy atnight have often gotten out of bed andstarted walking round and round until finallythe pain in their feet went away.
  67. 67. The reason why the pain was worseafter they had been off their feetwas that the nerves were “wakingup” and walking around made themgo “back to sleep”.
  68. 68. There is a strong correlationbetween foot neuropathy andfaulty foot mechanics.
  69. 69. The problem with only releasing anyentrapped nerves is that nothing is usuallydone to realign the foot.
  70. 70. Arch supports may be beneficial, but formany patients these devices just end uppushing on the nerves and make theirsymptoms worse.
  71. 71. A somewhat new and moreimportantly, scientifically proveninternal 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 thousandsof pediatric and adult patients since 2004.Stabilization of Joint Forces of the Subtalar Complex viathe HyProCure Sinus Tarsi StentJournal of American Podiatric Medical Association, Volume 101 No. 5, Pages 390-399, Sept/Oct 2011Extra-Osseous Talotarsal Stabilization using HyProCure in Adults: A5 Year Retrospective Follow-upJournal of Foot and Ankle Surgery – Vol. 51 (1), p. 23-29, 2012
  75. 75. HyProCure®is the only extra-osseous talotarsal stabilizationdevice that works with the normal mechanicsunlike other devices that work against the normalfunction and often leading to failure of the device.+ =
  76. 76. HyProCure®is the only medical treatment that has beenscientifically proven to decrease the pressures withinthe tarsal tunnel and porta pedis while at the sametime decreasing the strain on the nerve.The Effect of HyProCure Sinus Tarsi Stent on Tarsal Tunnel andPorta Pedis Pressures.Journal of Foot and Ankle Surgery, Volume 50, (1) Pages 44-49, January 2011Effect of Extra-Osseous TaloTarsal Stabilization on Posterior TibialNerve Strain in Hyperpronating Feet: A Cadaveric EvaluationJournal of Foot and Ankle Surgery, Volume 50, (6), Pages 672-675, November 2011
  77. 77. Every effort must be considered toeliminate any factor that could lead tothe destruction of peripheral nerves.
  78. 78. Generally speaking, the medicalestablishment has always beenagainst any surgical option.
  79. 79. We have followed their advice of:early detectionfrequent physician visitsstrict diabetic controlbut the disease still remains and often gets worse.
  80. 80. The need for early surgicalintervention is important.While standing, walking, orrunning the nerves to thebottom of the foot are beingdestroyed.
  81. 81. Eventually, the critical threshold isreached where there is no chance ofthe nerve to heal itself.
  82. 82. While we can’t ignore the fact that high bloodsugar, excessive alcohol consumption, and theother potential causes must be controlled oreliminated, we cannot ignore the simple factsof the trauma inflicted on the nerve as aresult of the faulty foot alignment.
  83. 83. The risk benefit analysis of theHyProCure®option shows that thebenefits are far greater then anypotential risks.
  84. 84. Let’s do all that we can to make adifference

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