Diabetic Neuropathy and Foot Pain: Strategies to relief

Diabetic neuropathy is a common complication of diabetes that affects the nerves, leading to various symptoms and complications. It’s estimated that around half of all people with diabetes will develop some form of neuropathy (1).

In this article you will learn:

• What is Diabetic Neuropathy?
• Types of Diabetic Neuropathy
• What causes Diabetic Neuropathy?
• What is Diabetic Neuropathy Diagnosis
• What are Diabetic foot pain complications?
• What is the best treatment for Diabetic Neuropathy?

Diabetic neuropathy is a type of nerve damage caused by long-term high blood sugar levels associated with diabetes (2). There are several types of diabetic neuropathy, including peripheral neuropathy, autonomic neuropathy, proximal neuropathy, and focal neuropathy (3). Each type affects different nerves and presents with unique symptoms and complications.

• Peripheral Neuropathy: affects the nerves that control sensation, typically in the feet and legs. Symptoms may include tingling, numbness, burning sensations, and pain (4).
• Autonomic Neuropathy: affects the nerves that control involuntary bodily functions such as digestion, heart rate, and bladder function. It can lead to problems with digestion, sexual dysfunction, and cardiovascular issues (5).
• Proximal Neuropathy: affects the nerves in the thighs, hips, or buttocks, causing pain, weakness, and difficulty moving (6).
• Focal Neuropathy: affects specific nerves, often causing sudden and severe pain in isolated areas such as the head, torso, or leg (7).

Symptoms can vary in severity and may worsen over time if left untreated (3)

The exact cause of diabetic neuropathy is not fully understood, but prolonged exposure to high blood sugar levels, along with other factors such as genetics, smoking, and alcohol consumption, can increase the risk (8). Poor blood sugar control, duration of diabetes, and other health conditions like obesity and hypertension also contribute to the development of neuropathy (2)

Diagnosing diabetic neuropathy involves a thorough medical history, physical examination, and various tests such as nerve conduction studies, electromyography, and blood tests (4). Early detection is crucial for preventing further nerve damage and complications.

Complications of diabetic neuropathy may include foot ulcers, infections, and even amputations. Peripheral neuropathy, in particular, increases the risk of foot-related complications due to reduced sensation and poor circulation (1). Diabetic foot pain is a common symptom of peripheral neuropathy, characterised by tingling, burning sensations, and sharp or shooting pains in the feet. It can significantly impact mobility and quality of life for individuals with diabetes. Proper foot care, including wearing supportive shoes, practising good hygiene, and checking for any signs of injury or infection, is essential for managing diabetic foot pain and preventing complications (4).

Effective management of diabetic neuropathy involves a multifaceted approach aimed at controlling symptoms, preventing further nerve damage, and improving overall quality of life for individuals with diabetes.

• Blood Sugar Control: Maintaining optimal blood sugar levels is crucial for managing diabetic neuropathy (3). This involves adhering to a diabetes management plan prescribed by a healthcare provider, which may include monitoring blood sugar levels regularly, following a balanced diet, engaging in regular physical activity, and taking medications as prescribed (2).
• Nutritional Support: A balanced diet rich in nutrients can support overall health and may help manage diabetic neuropathy symptoms (8). Emphasising whole foods such as fruits, vegetables, lean proteins, and whole grains while limiting processed foods, added sugars, and unhealthy fats can contribute to better symptom management and overall well-being. Additionally, incorporating low glycemic index (GI) foods into the diet can help stabilise blood sugar levels and reduce the risk of spikes, which can exacerbate neuropathic symptoms. Choosing carbohydrates that are low on the GI scale, such as whole grains, legumes, and non-starchy vegetables, can help provide sustained energy and promote better blood sugar control. Dietitians can provide personalised dietary advice and support to help individuals with diabetes make healthy food choices and optimise their nutrition (1).
• Physical Therapy: Physical therapy can be beneficial for individuals with diabetic neuropathy (1). It focuses on improving strength, flexibility, balance, and coordination. A physical therapist can develop a personalised exercise program tailored to the individual’s needs and abilities. Exercises may include stretching, strength training, balance exercises, and aerobic activities. Physical therapy can help reduce pain, improve mobility, and prevent falls and injuries associated with neuropathy.
• Medications: Several medications may be prescribed to manage the symptoms of diabetic neuropathy (5). Pain relievers such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioid medications may help alleviate mild to moderate pain. Antidepressants such as tricyclic antidepressants (TCAs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs) can help relieve neuropathic pain. Anticonvulsant medications such as gabapentin and pregabalin may also be prescribed to help control nerve-related pain.
• Transcutaneous Electrical Nerve Stimulation (TENS): TENS is a non-invasive therapy that involves applying electrical stimulation to the skin over the affected area using small electrodes (). TENS therapy may help alleviate neuropathic pain by interfering with the transmission of pain signals to the brain. It can be used as a standalone treatment or in combination with other therapies to manage diabetic neuropathy symptoms.
• Alternative Therapies: In addition to conventional treatments, some individuals with diabetic neuropathy may find relief from alternative therapies such as acupuncture, biofeedback, and nerve stimulation techniques (7). While the effectiveness of these therapies may vary, some people report improvements in pain and symptom management with alternative approaches.
• Foot Care: Proper foot care is essential for preventing diabetic foot complications such as ulcers, infections, and amputations (2). Individuals with diabetic neuropathy should inspect their feet daily for cuts, blisters, sores, or other signs of injury. They should also keep their feet clean and dry, wear comfortable shoes that fit well, and avoid going barefoot or wearing tight-fitting footwear. Regular foot exams by a healthcare professional are recommended to detect any issues early and prevent complications.

Managing diabetic neuropathy requires a comprehensive approach that addresses the underlying causes, controls symptoms, and reduces the risk of complications. By working closely with healthcare providers and adopting healthy lifestyle habits, individuals with diabetes can effectively manage their neuropathy and improve their overall quality of life.