Advanced wounds, such as ulcerations, on upper or lower extremities sometimes may require amputation of the extremity. In these situations, reconstructive surgical options can be discussed with a plastic surgeon. Individuals with diabetes should be aware that ulcers and wound problems may develop because of diabetic neuropathy. Sensory testing for diabetic neuropathy may offer early diagnosis and a wider range of treatment options.
For more information about diabetic neuropathy and nerve compression, or to make an appointment, please call Maria Siemionow, MD, PhD, at Cleveland Clinic Main Campus at 216.445.2405 or 800.223.2273, ext. 52405.
Important News For Diabetics: Early Diagnosis of Diabetic Neuropathy and Related Nerve Compression Syndromes Offers Best Results
The most common chronic complication of diabetes is diabetic neuropathy, a serious nerve disorder that affects the legs and feet, and causes ulcerations, infections and, in advanced cases, amputation.
Without proper prevention or early detection with proper treatment, diabetic neuropathy can lead to severe complications.
Also common among diabetics are superimposed nerve compression syndromes (NCS), a consequence of long-lasting diabetic neuropathy. With early detection and treatment, sensation and strength can be restored to patients with NCS. (More about NCS below.)
Frequently Asked Questions
Who should be concerned?»
Anyone with diabetes, both Type 1 (also known as juvenile or insulin-dependent diabetes) and Type 2 (also known as adult or non-insulin-dependent diabetes), should be concerned about diabetic neuropathy. According to the statistics, half of all people with diabetes will develop diabetic neuropathy during their lifetimes.
Can diabetic neuropathy be prevented or delayed? »
To stay healthy, diabetics should be taught by a specialist how to:
- Maintain a proper diet and exercise routine
- Keep blood glucose levels under control
- Keep cholesterol levels and blood pressure down
- Maintain a proper grooming and hygiene regimen
In addition, diabetics should be sure to wear properly fitting clothing, particularly shoes; avoid smoking; and keep alcohol intake to a minimum.
What are the symptoms of diabetic neuropathy? »
Early symptoms include tingling, loss of sensation, numbness, weakness and poor circulation in legs, feet and hands. These symptoms easily can lead to accident and injury. Later the patient may feel pain of varying intensity. Skin problems such as sores, blisters, calluses or wounds are common and often get infected. These problems lead to ulcers or widespread bacterial infections that frequently cause gangrene, for which the only treatment is amputation.
How is diabetic neuropathy diagnosed in its early stage? »
To detect diabetic neuropathy early, diabetics need to be taught by a specialist to perform daily self-examinations. In addition, a trained physician should perform frequent nerve and muscle function evaluations. Finally, objective quantitative sensory testing is recommended at least twice a year.
Like most conditions and diseases, the earlier they are detected, the better the chances are for successful treatment.
What is quantitative sensory testing? »
Quantitative sensory testing (QST) is the method of measuring the degree of sensory nerve function impairment in the fingers and toes. The test can tell the physician how serious diabetic neuropathy has become. The test is performed using a special device that doesn’t require needles or electric shocks and is not stressful for the patient.
What are the benefits of QST?»
A QST is a quick, easy and accurate method of testing the nerves of the lower and upper extremities. In addition to clinical examination by a specialist, the test can detect nerve compression syndromes. A QST helps physicians to make the proper treatment decisions, both conservative and surgical.
What are nerve compression syndromes? »
Nerves running in the upper and lower extremity are known as the peripheral nerves, and they are found between muscles, ligaments, bones and tendons. Nerves that run through narrow channels, such as the wrist and ankle, are more likely to become constricted or compressed.
In persons with diabetes, these nerves are often swollen, making them even more susceptible to compression. When compressed for a long time, permanent damage to the nerve is inevitable. The most common compression nerve syndromes are carpal tunnel syndrome (wrist), cubital tunnel syndrome (elbow region), radial tunnel syndrome (forearm), peroneal nerve syndrome (below the knee) and tarsal tunnel syndrome (ankle).
How are nerve compression syndromes treated? »
In early stages of NCS, conservative treatment can be applied. In advanced stages, however, surgery to release the compression of the nerves is usually required.
By releasing the pressure on the nerves, blood flow to the nerve is improved and further damage prevented. Even in advanced stages, surgery may help prevent additional damage in the future. However, if surgery is delayed, the damage may be irreversible. In these situations, once ulceration and chronic wounds develop, reconstructive surgical options can be discussed with the specialist.
This information is for educational purposes only and should not be relied upon as medical advice. It has not been designed to replace the independent judgment of a physician about the appropriateness or risks of a procedure for a given patient.
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