The Diabetes and Foot Pain Connection

By

Nancy LeBrun

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Foot Pain

People with diabetes often develop pain in their feet that they describe as tingling, burning, stabbing or shooting sensations.  It can be intense enough to make daily activities and even sleeping difficult. This kind of pain is called peripheral neuropathy, and more than half of those with diabetes will experience it. It may start as mild discomfort, or it may come on suddenly and severely. The longer you have diabetes, the more likely it is that you will develop foot pain - and experts aren’t sure why, but the symptoms are often worse at night. So, what’s the link between diabetes and foot pain?

What causes diabetic foot pain?

When you have diabetes, your body doesn’t process glucose - a form of sugar - like it should. That results in high levels of sugar and fat in your blood. After many years, this restricts blood flow in your smallest blood vessels, keeping your system from delivering enough oxygen and nutrients to your nerves, which can cause damage. The affected nerves don’t send signals to the brain, which can cause numbness, or they can send signals randomly, triggering the shooting and burning sensations. The small nerve fibers that are the farthest from your spinal cord – the ones in your feet – are the most vulnerable.  And that’s why people with diabetes may develop foot pain.

Can I prevent diabetic foot pain?

To lessen your risk of developing foot pain, it’s important to maintain healthy blood sugar levels. Your healthcare team can help you set the numbers to shoot for and advise you how to keep them there. Make sure you take your diabetes medicine and avoid smoking, which narrows and weakens the blood vessels that feed the nerves. Staying active, eating a healthy diet as directed by your doctor, and maintaining a good weight is important for the general health of your nervous system as well as keeping your diabetes under control.

What are the complications of damage to the nerves in my feet?

Peripheral neuropathy can make your feet numb to temperature changes and injury. You may not be aware of burns, cuts and blisters on your feet that can become infected. This problem is intensified because foot wounds heal very slowly in diabetics. It’s important that you check your feet for injuries regularly, so you can take care of any problems while they are minor. If you don’t, you may develop serious infections. The worst-case scenario may require amputation.

What treatments might help my foot pain?

Your healthcare provider can prescribe medication that can help foot pain, among them antidepressants and anticonvulsants. You don’t have to be depressed or have seizures to take these medicines to ease the discomfort. And some studies have shown that prescription nitrate sprays may also help the burning sensation and overall pain.

There are also treatments you can get over-the-counter and put directly on the skin of your feet, including capsaicin cream, which you can apply three to four times a day, as long as you don’t put it on open wounds.  You can also use lidocaine patches, which can help by numbing the area. There is some evidence that taking a supplement called alpha lipoic acid, which is an antioxidant, relieves peripheral neuropathy, but it’s still being investigated. These treatments can be used in addition to other medications you are taking, but be sure to talk to your healthcare provider before you begin using them.

Some people find relief with acupuncture, which may stimulate the body’s natural painkillers.  And, if you are having trouble with balance, coordination or walking, physical therapy may also help.  If the pain is causing you stress, try biofeedback or yoga to help you manage it.

If you find that wearing shoes makes you uncomfortable, you can get specially designed soft footwear and socks with extra padding and fewer seams.  If sleeping is difficult because the bedding is rubbing your feet, look into devices that keep the sheets lifted and off your feet at night to lessen irritation.

Diabetes and foot pain may go together all too often, but there are ways to manage it and minimize the damage and discomfort. If you have diabetes, be sure to discuss a plan to keep your feet healthy with your healthcare provider.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Apr 15, 2016

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Medical References

  1. Treatment of Chronic Painful Diabetic Neuropathy with Isosorbide Dinitrate Spray. Diabetes Care. 2002;25(10):1699-1703. http://care.diabetesjournals.org/content/25/10/1699.full.pdf
  2. Diabetic Neuropathies: The Nerve Damage of Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies
  3. Groninger H, Schisler R. Topical Capsaicin for Neuropathic Pain. J Palliat Med. 2012;15(8):946-947. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462404/
  4. Acupuncture. Mayo Clinic. http://www.mayoclinic.org/tests-procedures/acupuncture/basics/definition/prc-20020778
  5. Snyder MJ, Gibbs LM, and Lindsay TJ. Treating Diabetic Peripheral Neuropathy Pain. Am Fam Physician. 2016;94(3):227-234. https://www.aafp.org/afp/2016/0801/p227.html

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