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Published on April 15, 2016

The pain your feet can’t always feelThe pain your feet can’t always feel

Tara Valley-Guiliano of Falmouth lives with the pain of diabetic neuropathy every day.

“It feels like I’m being electrocuted in my feet,” she said.

It can be worse at night when she’s not busy with daily activities and all is quiet.  There is no rhyme or reason to the “zaps” to her feet that can wake her up in the middle of the night, she said.

Valley-Guiliano’s symptoms began two years ago with numbness and tingling in her toes, and worsened over the past year. She also developed pins and needles and an ultrasensitive sensation in her arms. One day she noticed a blister on her arm where she had burned herself on an oven rack and didn’t even realize it.

Diabetic neuropathy is a group of nerve disorders caused by diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIH). Approximately 60-70 percent of diabetics have some form of it.  Nerves throughout the body can be affected and impact all organ systems, including the digestive tract, heart and sex organs.

The most common form of diabetic neuropathy is peripheral neuropathy, according to NIH and causes nerve damage to the arms and legs often resulting in pain and numbness in the hands and feet.

It’s Not Always Painful

While Valley-Guliano endures the pain of peripheral neuropathy, most patients with this type of neuropathy do not have pain in their feet, said Angela Boldo, MD, an endocrinologist at Falmouth Hospital.

“Every time a diabetic patient comes to the office, we screen them for neuropathy and we check their feet,” she said. “We stress the importance of checking their feet every day at home.”

Tests for neuropathy in the hands and feet include:

  • Asking questions about pain and numbness
  • A prick test with a mono-filament to check for sensation
  • A tuning fork to check the sensation of vibration.

One of the concerns with peripheral neuropathy, especially in the feet, is related to sensation. If a patient has non-painful neuropathy, they can injure their feet or develop a wound and not know it, said Dr. Boldo.  If they keep stepping on the wound, it can become infected and cause multiple problems.

She also advises all of her diabetic patients to have a podiatrist cut their nails so they don’t risk injuring themselves especially if they have neuropathy.

Another way to protect the feet is to wear shoes or sandals. One of Valley-Guiliano favorite things to do before developing neuropathy was to walk barefoot on the beach, but now she always wears sandals, she said.

Once the diagnosis is made, treatment depends on their level of pain and numbness. If there is no pain or numbness, then there is no treatment necessary.

“If the numbness is bothering them, or they have pain, then there are medications to help relieve the symptoms, such as Gabapentin, Lyrica and Cymbalta,” said Dr. Boldo.

Medications can be combined if one is not working or change the medication as needed.

The goal is to prevent the neuropathy from developing in the first place. “Good glucose control is better at preventing neuropathy than preventing the progression of it,” Dr. Boldo said.