Painful Feet: A Common But Often Avoidable Complication of Diabetes

Mohini Gurme, MD

Painful Feet: A Common But Often Avoidable Complication of Diabetes

Diabetic nerve damage, or neuropathy, is a common and serious complication of diabetes that most often affects the feet. You can often prevent diabetic neuropathy or slow its progression if you tightly control your blood sugar, says Mohini Gurme, MD, a neurologist at Rockland Neurological Associates in West Nyack, NY.

“Diabetic neuropathy is most common in people who have had diabetes for 15 to 20 years, or those with poorly controlled diabetes,” Dr. Gurme says.

Diabetic neuropathy most often damages nerves in the legs and feet. A person with nerve damage may feel numbness, tingling, or pain. Other symptoms include a reduced ability to feel pain or temperature changes; increased sensitivity to touch (even being touched by a bed sheet can be extremely painful); loss of reflexes, especially in the ankle; loss of balance and coordination; and serious foot problems, such as ulcers, infections, deformities, and bone and joint pain.

To diagnose diabetic neuropathy, the doctor may use several tests. These include nerve conduction studies, which measure how quickly the nerves in the arms and legs conduct electrical signals, and electromyography (EMG), which measures the electrical discharges produced in the muscles. Dr. Gurme notes that nerve pain can also have other causes, including vitamin deficiencies and certain autoimmune diseases.

The most important way to prevent diabetic neuropathy is to keep your blood sugar within the target range recommended by your doctor. For people who already have nerve pain, keeping blood sugar under control may improve some symptoms they already have.

There are several drugs used to treat nerve pain symptoms. These include gabapentin (Gralise, Neurontin) and pregabalin (Lyrica). Drowsiness is a common side effect. “You shouldn’t take these medications along with other sedatives,” Dr. Gurme cautions. “A person doesn’t necessarily have to take these drugs permanently,” she adds. “Because diabetic nerve pain can fluctuate, we can reassess the need for medication if the pain gets better.”

Some patients find relief with lidocaine patches or capsaicin cream (made from chili peppers). Dr. Gurme also finds that some patients are helped by taking vitamin B12 supplements.
She recommends that patients with diabetic nerve pain take regular walks. “Some people with diabetic nerve pain don’t want to walk, because they have trouble with their balance and pain in their feet,” she says. “But walking helps improve balance. If a person has trouble walking, I recommend using an assistive device such as a cane or walker. Some people can benefit from physical therapy to strengthen muscles for their balance.”

Patients with severe neuropathy may prefer to engage in non-weight-bearing activities, such as swimming or bicycling.

Dr. Gurme advises people with diabetic nerve pain to wear shoes with a wide base—sneakers are best. “I also tell my patients to see a podiatrist, who will help them keep their nails short to reduce their risk of infection or sores.”

If you have neuropathy, you should see your doctor every three to six months. “If your balance worsens, or if your pain increases despite medication or you have cuts or sores on your feet that are not healing, see your doctor right away,” Dr. Gurme says.