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By Dr. Sarah Voelkel
KyForward columnist

Burning pain in your feet keeping you up at night?
Since this is Diabetes Awareness Month, we’re chatting about a topic that plagues many with diabetes. Burning, sharp, shooting pains can be the norm for some diabetics’ feet.  
These symptoms are called peripheral neuropathy.  Peripheral neuropathy can be a very debilitating condition affecting your everyday activities and even your ability to sleep at night. 
Peripheral neuropathy is caused by damage to the nerves.  Most commonly, the feet and hands are affected first.  In a diabetic, peripheral neuropathy is caused by elevated glucose levels over time which damage the nerve tissue.
Other common causes of peripheral neuropathy include alcoholism, autoimmune disorders, exposure to heavy metals or chemicals, certain infections such as Epstein-Barr virus or HIV, certain medications like chemotherapeutic agents, trauma to a nerve, vitamin deficiency and an underactive thyroid. 
What does it feel like?
Symptoms initially begin as burning, sharp shooting pains and temperature changes from feet feeling very cold to burning hot.  As peripheral neuropathy progresses, the symptoms may travel up your legs and muscle weakness and lack of coordination may set in.  Eventual complete numbness may result.

What should you do?
The earlier you are seen for this, the better your outcome may be.  During the initial visit to a podiatrist, you have a full physical exam evaluating muscle strength, your ability to feel different sensations, reflexes and coordination.  Lab work may also be done for further evaluation.
A lower leg or foot nerve skin biopsy may be done in the office to evaluate the density of skin nerve fibers, which are known to decrease in peripheral neuropathy.  You may also need to have a nerve conduction study to evaluate which nerves are mostly affected and to what extent they are damaged. 
There are certain medications that can help with the symptoms of peripheral neuropathy, but they can have unwanted side effects. Your doctors will work with you to determine whether they outweigh the pain of the neuropathy or not.  Not only do we treat the pain of the neuropathy, but we also focus on treating the underlying condition, if known, and try to improve the health of the nerve. 
What can prevent progression?
If the underlying condition is known, then adequate treatment of this can help prevent progression of the peripheral neuropathy and even help improve symptoms.  To help improve the health of the nerve, we recommend vitamin supplementation. 
Laser therapy is one of the latest medical advancements in the treatment of neuropathy symptoms.
Remember, the earlier you get treated for neuropathy, the better your outcome. Don’t delay – when there is pain in your feet, it’s best to take a step in the right direction sooner than later.


Dr. Sarah Voelkel is a foot and ankle surgeon at Lexington Podiatry and the Kentucky Heel Pain Center.


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