Diabetic Foot Conditions: Neuropathy & Nerve Compression

Diabetics and Peripheral Neuropathy

A diminished capacity to metabolize sugar (glucose) puts diabetics at risk for a complication known as neuropathy. The nerve’s response to abnormally high sugar levels can occur in diabetics even when blood sugar levels are maintained at normal levels.

Diabetic neuropathy begins with a change in sensation in the hands and feet. Diabetics experience the same numbness and tingling sensation that is seen in people who experience regular nerve compression, but it involves both the hands and both feet. Usually the feet begin to feel pain prior to the hands.

When neuropathy begins in the foot, the top and bottom of the limb is affected. The changes can occur in all of the toes and extend up to the knee. With diabetic neuropathy, multiple nerves are compressed at a number of sites along the nerve’s path from below the knee down to the foot.

Is Diabetic Neuropathy Different from Nerve Compression?

Yes. Regular nerve compression usually involves one nerve in the arm or the leg, resulting in symptoms of numbness in that single region. The difference in the pattern of numbness is the main reason doctors have not previously associated symptoms of diabetic neuropathy with those of nerve compression.

Another difference between diabetic neuropathy and nerve compression is, the diabetic nerve is compressed due to a faulty metabolic process that inflames the nerve.

Why are Diabetics Prone to Nerve Compression?

When  peripheral neuropathy and nerve compression exist together, the symptoms of numbness, tingling and weakness exist due to nerves being compressed.

Diabetic nerve compression is primarily the result of a metabolic imbalance that causes nerves to become swollen. This inflammation influences tightness in the surrounding area and increased pain on top of the original neuropathy. Consequently, a diabetic's nerves are susceptible to compression because the diabetic’s nerves are swollen.

Metabolic Reasons for Neuropathy

Blood sugar (glucose) enters the nerve, like it enters other cells, to provide energy. The glucose is then converted to another sugar called sorbitol. Sorbitol's chemical nature makes it highly attractive to water molecules, and so water is drawn into the nerve, causing it to swell.

If the nerve swells in a place that is already tight, such as the feet and hands, the nerve becomes pinched or compressed, resulting in numbness and tingling.

The second reason for swelling is related to the transport systems within the diabetic nerve. The nerve is filled with a substance that allows important chemical messengers to move along it, enabling one end of the nerve to know what is happening at the other end. If the nerve becomes damaged by compression, it is unable to repair itself properly, rendering it more likely to remain in trouble from compression.

Should I Have Surgery?

While it’s not fully understood how to prevent neuropathy from occurring, there are methods available to slow the natural course of diabetic neuropathy. This is done by removing the compression, or tight areas along the course of the nerve, that are causing numbness and tingling in the hands and feet.

Surgery to decompress the nerve does not change the basic underlying causes of metabolic (diabetic) neuropathy. However, when surgical decompression is performed early in the course of nerve compression, restoration of blood flow will stop the numbness and tingling, and allow the nerve to recover.

When decompression is done later in the course of nerve compression, and there have been extended periods of symptoms, the nerve fibers have already begun to die, and decompression may facilitate regrowth of the diabetic nerve.

UFAI, The Best Choice for Diabetic Peripheral Neuropathy & Nerve Compression Treatment

From preventative lecture series and diabetic shoe programs to salvage of severe ulcerated feet and neuropathy, the Foot and Ankle Institute is a world leader in state-of-the-art diabetic foot care. The latest techniques for diabetic therapy are available in our center.

Our doctors, surgeons and physical therapists are nationally recognized as the best foot and ankle specialists in California. They have decades of experience treating diabetic issues and understand the unique circumstances surrounding diabetes and feet.