Diabetic Neuropathy

In clinic this past week, we heard from Dr. Natasha Hunter regarding diabetic neuropathy.

As summarized in a paper Dr. Hunter circulated:

"Neuropathy leads to an insensitive and sometimes deformed foot, often with an abnormal walking pattern. In people with neuropathy, minor trauma – caused for example by ill-fitting shoes, walking barefoot, or an acute injury – can precipitate a chronic ulcer. Loss of sensation, foot deformities, and limited joint mobility can result in abnormal biomechanical loading of the foot. Thickened skin (callus) forms as a result. This leads to a further increase of the abnormal loading and, often, subcutaneous hemorrhage.

Whatever the primary cause, the patient continues walking on the insensitive foot, impairing subsequent healing. Peripheral vascular disease, usually in conjunction with minor trauma, may result in a painful, purely ischemic foot ulcer."

Dr. Hunter discussed with the group the importance of patient education regarding feet inspection, and the need for another person with skills to inspect the feet of a patient suffering from diabetic neuropathy.

Source: J. Apelqvist et al. "Practical guidelines on the management and prevention of the diabetic foot." Diabetes Metab Rev 2008.