• Reference Number: HEY-375/2016
• Departments: Diabetes
• Last Updated: 1 June 2016

Introduction

This leaflet has been produced to give you general information about Diabetic Peripheral Neuropathy.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your healthcare professional, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is peripheral neuropathy?

Neuropathy is the term used to describe the damage that can happen to the nerves in people who have diabetes. The nerves carry messages to and from the brain to all the other parts of the body. There are different types of nerves that are part of the control system for our body. These are:

• Sensory nerves that tell the brain what is happening by registering different sensations such as heat, cold, pain, touch and joint position.
• Motor nerves that tell the muscles to move.
• Autonomic nerves that automatically control almost all the organs in our body such as the heart, bowels, bladder, skin and lungs.

When neuropathy affects the nerves that go to and from our feet and hands it is called peripheral neuropathy. Peripheral neuropathy is common in people with diabetes and the chance that you will develop peripheral neuropathy increases the longer you have diabetes.

What causes peripheral neuropathy?

The cause of peripheral neuropathy in people with diabetes is not fully understood but there are likely to be a number of factors involved. High blood glucose levels over a long period of time have been shown to increase the risk of developing peripheral neuropathy. Lifestyle factors, such as smoking and alcohol intake, disorders of the immune system, infectious diseases and certain nutritional deficiencies may also contribute to the nerve damage. The most likely cause of peripheral neuropathy is damage to the small blood vessels that feed the nerve.

How does peripheral neuropathy affect the feet?

The most common form of peripheral neuropathy in the feet is sensory neuropathy. This type of neuropathy reduces the ability to feel things such as touch, heat, cold and pain. Sensory neuropathy can cause people to feel sensations like numbness, tingling and pain, but most people will not know that the nerves have been damaged.

Losing the ability to feel can increase the risk of injury to your foot. Injury can be caused by badly fitting shoes, stones or sharp objects, heat from radiators, baths and hot water bottles or any other type of damage. If an injury does happen it may go unnoticed for longer and become worse. If left, an injury may become infected or develop into an ulcer, which can take a long time to heal. In some cases this may not heal and surgical intervention in the form of an amputation may be required.

Loss of feeling in the foot can mean that it is possible to break a bone or dislocate a joint with little or no pain, even from a minor injury. This can then lead to a serious complication called Diabetic Charcot Foot where the foot can become very inflamed and permanently deformed.

Some people will experience painful symptoms in their feet. The pains can range from mild to severe cramping, tingling, burning or shooting pains which are often worse at night.

Motor neuropathy affects the control of the muscles in the feet and can cause the foot to change shape. The toes may become clawed and the arch of the foot can change shape. These changes in foot shape can put increased pressure on parts of the foot, making them more prone to hard skin, corns and foot ulcers.

Autonomic neuropathy can stop the sweat glands working resulting in dry skin, especially around the heels. If left, the dry skin may build up and cause pressure or even crack, which in turn could develop into a foot ulcer.

Is there a cure for peripheral neuropathy?

At the moment there is no cure for neuropathy, but there are treatments that can help to relieve the symptoms. It may be possible to reduce the risk of developing neuropathy, or prevent it from getting worse, by keeping your blood glucose levels under control.

Research is taking place into neuropathy and various drugs are being tested to see if they can reduce the nerve damage associated with diabetes.

Looking after feet with peripheral neuropathy

• Inspect your feet every day. Check underneath your feet with a mirror or ask a friend or family member to help.
• Wash your feet every day. Test the water first with your elbow or a thermometer to make sure that it is not too hot. Use a soft cloth or cotton wool to clean between your toes each time you wash.
• Dry your feet thoroughly with a soft towel. Make sure you dry thoroughly and gently between your toes. Use moisturising cream every day on dry skin; avoid putting this between your toes
• Avoid temperatures that are too hot or cold. Do not use hot water bottles, heat bags or expose your feet to high temperatures.
• Change your socks or tights every day. Choose socks or tights that are a good fit and have smooth seams that will not rub your toes.
• Do not walk bare foot and ensure your shoes and slippers are the correct size and fit for your feet. Wear new shoes and slippers in gradually to ensure they do not rub.
• Check inside your shoes before you put them on to make sure there is nothing inside them and check that the linings and insoles are not wearing out or becoming rough.
• Do not use corn preparations or hard skin removers and avoid anything that may dry or irritate your skin.

Remember you may not feel an injury to your foot. If you see any changes to your foot, such as:

• Red, itchy or sore skin, blisters, open wounds or cracked hard skin.
• If your foot becomes swollen or if there is a discharge of any kind.
• A part or all of your foot becomes much hotter than normal.
• A part or all of your foot becomes painful.
• Your feet have an unusual smell.

Seek immediate medical advice if you are generally unwell with nausea, vomiting and high temperature.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact:

Diabetes Foot Protection Team,
The Diabetes Centre,
Brocklehurst Building,
Anlaby Road,
Hull, HU3 2RW.

Telephone number: (01482) 675345. (Monday to Friday 8:30am to 5.00pm.)

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

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We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.