Lately, I have seen an increase of patients coming to the clinic with foot injuries. Not your typical “I tripped, stumbled, and twisted my ankle” kind of injuries.  More like:

Nurse Sarab: “Did you know you have a wound/ulcer on the sole of your foot”

Patient: “What?”

Nurse Sarab: “Hmmm… when did you step on broken glass? Because there is a piece of glass stuck in your foot, and it has caused an infection to your ulcer!”

Patient: “I don’t know, I think I broke something a few days ago, or was it was few weeks ago?”

Unfortunately, this is a classic Peripheral Neuropathy scenario.

What is peripheral neuropathy? Neuropathy is a condition that causes tingling, numbness and/or damages to the nerves. Often people complain of these symptoms in their hands and in their feet. As a Foot Care Nurse, I am more concerned when these nerve damages occur in the feet, because it leads to a loss of protective sensation. This means that if my patient walks/steps on something, barefoot, they won’t feel it. Our feet are far from our eyes and hands, and are naturally neglected.  Often, these foot injuries are left untreated because they haven’t been noticed. This increases my patients’ chances of getting an infection which can complicate things even more. Needless to say that neuropathy in the feet is a morbid combination.

Does neuropathy only affect diabetic patients? No, we see it in those affected by cancer and spinal nerve injuries. There are many other causes such as chemotherapy, infections, autoimmune diseases, vitamin deficiencies, smoking, use of recreational drugs, alcoholism, genetics, and other traumatic injuries. However, the most common cause is diabetes. Uncontrolled and elevated blood sugar levels cause damages to the blood vessels and the nerve endings. And since our feet are the furthest body part from our heart (our blood circulation pump), they are naturally struggling with poor circulation. Adding neuropathy to this combination complicates things even more.

So what about this loss of sensation? This explains why my patients don’t feel anything when they step on sharp objects like glass, or a small rock in their shoe. They don’t realize that their foot is injured and they don’t realize there is an infection because they cannot feel the pain and the swelling. I’m not here to scare you, but people who suffer from peripheral neuropathy are at a high risk of foot injuries and infections. When these infections become serious, this increases their risk of a lower limb amputation. What is the sad part out of all this? Studies show that 85% of these amputations could have been prevented.

What else does neuropathy affect? Neuropathy can also affect your balance, mobility and strength. How? Neuropathy leads to nerve damage and there are different types of nerves in the body from sensory (sensation) to motor (muscles). When sensory nerves are damaged, people lose sensation of touch, pressure, heat, vibration, reflexes and so on. When motor nerves are damages, this can cause muscle weakness, pain, cramps and atrophy. Muscle weakness in the feet can cause a “foot drop” which forces the foot to be dragged on the floor, thus increasing the risk of injuries to the affected foot.  We won’t get into the big medical terminologies, but this all explains how people affected by neuropathy often complain about feeling like they’re losing their balance, why they have trouble with walking and coordination and why they feel as they’re not as strong as they use to be on their feet. And if you wondered, yes, neuropathy can increase your risk of falls.

Alright Nurse Sarab, I’ve learned enough. Tell me, how can you help me? Any health condition should always be addressed to your primary health care provider. But it is important to have a “health team approach”. You are not alone, we all work together. As your Foot Care Nurse, my goal is to keep you active and strong on your feet. While I do provide treatments, I focus a lot of preventive strategies because prevention is the best medicine! Here is my TOP 6 STEPS to help you live comfortably with peripheral neuropathy:

1. CHECK YOUR FEET: A daily visual inspection is what it takes to know there is problem with your feet. Can’t reach your feet? Use a hand held mirror, or ask for a friend or family member to help. Not sure if things are better or worse? Snap a picture with your phone, and call your Foot Specialist (a.k.a. me 😉 )

2. AVOID BEING BAREFOOT: There is some science behind walking barefoot, but the risk of injuries outweighs its benefits. Always have something protecting and covering your feet such as socks and slippers. Avoid walking barefoot inside and outside. I have pulled out plastic pebbles, glass, dog hair and human hair out of people’s feet. Enough said!

3. DON’T WAIT: It’s red, hot, swollen, painful OR oozing. Get that addressed like yesterday! Infection = antibiotics. It will not go away on its own, and it WILL become a bacterial buffet. Don’t risk it. And when you are on antibiotics, take them for its ENTIRE course! You should NEVER have leftover antibiotics.

4. SHOES, SLIPPERS AND SANDALS, OH MY! Good footwear is key to keep your feet healthy. Bad footwear can lead to blisters, ulcers, corns and calluses that can become easily infected. Not worth it. As your Foot Care Specialist, I can help you find a good pair of footwear that offers support, strength, stability, comfort and of course, style.

5. CHECK YOUR SHOES: While we are on the subject, check inside your shoes. Rocks and other small objects can easily hide in your shoes, causing pressure and injuries to your feet without you knowing. Take 30 seconds to give your shoes a « check and shake off » to remove any foreign objects out.

6. SEE YOUR FOOTCARE SPECIALIST: We are an IMPORTANT member of your healthcare team. Your feet will thank us. Don’t attempt doing any bathroom surgeries on your own corns, calluses, thick toenails, ingrown toenails, fungal toenails… leave it to the specialists! We can also monitor your neuropathy to keep track of your condition in your records.

Some conditions have no cure, but that doesn’t mean you’ve hit a dead end. The important thing is to find management strategies that allow you to live a healthy life. Some people will request pharmaceutical options while others look for lifestyle changes. Some people want to integrate a combination of modern medicine with alternative medicine. Management will require trial and error. What works for you may not work for your loved one or a friend, and what works for them may not work for you. Find what is right for you, but do not give up. Your health is not an expense, it’s a lifelong investment!

Nurse Sarab