Symptoms of neuropathy depend on whether autonomic, sensory, or motor nerves — or a combination of them — are involved. Autonomic nerve damage can affect bodily functions or blood pressure, or create gastrointestinal symptoms. Damage to sensory nerves can affect sensations and sense of balance, while damage to motor nerves can affect movement and reflexes. When both sensory and motor nerves are involved, this is a condition known as sensorimotor polyneuropathy. (1) As the damage progresses, complications can arise, such as: Specifically with diabetic neuropathy, “If there’s diminished sensation in the feet, there can be areas of increased pressure that can cause sores or ulcers,” says Matthew Villani, DPM, of HCA Florida Lake Monroe Hospital in Sanford, Florida. Ulcers, where the tissue breaks down, can be treated with debridement (removing dead cells), antibiotics, and taking pressure off of an affected area, such as using crutches or a wheelchair, until the ulcer heals. (2) If caught quickly, gangrene can be treated with antibiotics, surgery, and oxygen therapy. Likewise, a bone infection can be addressed with antibiotics and surgery. But, Villani says, “commonly, amputations are required if it does progress to that point.” It’s a common problem among people with diabetes: In 2016, about 130,000 people with a form of diabetes were discharged from the hospital after having a lower-extremity amputation. (3,4,5) The best treatment is prevention, advises Dr. Highlander. “Don’t let a small injury get out of control,” he says. Inspect your feet, or whichever part of your body is affected by numbness or other neuropathic symptoms, on a daily basis. “Look at the bottoms and backs of your feet. Purchase a plastic mirror that you can keep at your bedside to look at the bottoms of your feet if you are not flexible enough to see the bottoms on your own, or have a loved one check them.” Any blisters, abrasions, or injuries should be addressed by a doctor. Treatments of CAN tend to focus on symptom control, such as drinking plenty of fluids to raise blood volume and wearing compression stockings. Medication can also be prescribed to control low blood pressure and arrhythmia, including fludrocortisone (Florinef) and midodrine (Proamatine). Your heart function should be regularly monitored by a doctor if you have this condition. (6,7) Other treatment options include prokinetic medications (such as metoclopramide, domperidone, erythromycin, azithromycin, and cisapride), decompression or feeding tubes, surgery (such as pyloroplasty or gastrojejunostomy), and gastric electrical stimulation. In general, patients should seek advice from their endocrinologist or gastroenterologist if gastroparesis is present. If your doctor recommends surgery, this condition may make the procedure more complicated, says Highlander. “A neuropathic ankle fracture is at much higher risk for complications, and so it should be treated differently. If a patient knows they have neuropathy, that should be brought up before surgery,” says Highlander. Treatment of Charcot focuses on stabilizing the affected area (with a cast, for instance), avoiding too much weight-bearing, and reducing the swelling. (10) Treatments include bladder-relaxing medication, such as oxybutynin (Ditropan), tolterodine (Detrol LA), or propantheline (Pro Banthine); ones that stimulate bladder nerves, such as bethanechol; botulinum toxin; GABA supplements; and anti-epileptic drugs. (11) A key to preventing complications of neuropathy is to address the underlying condition and seek treatment early. For instance, Highlander says that certain nerve surgery procedures he performs work better when the patient still has some feeling in the affected nerve. “However, there’s a tight window of time in which you can do that,” he says. Once the neuropathy has progressed to total loss of sensation, the surgery is less likely to improve symptoms. Don’t let the window close on the time that you can address your own neuropathic symptoms and avoid complications.
