A Podiatrist's View

by Dr. Michael,MD Podiatrist

I am a retired Podiatrist, who for 15 years worked predominantly with patients diagnosed with diabetes. The risk factors affecting the lower extremities among diabetic patients include a potential for the loss of protective sensation, and an acceleration of atherosclerosis (clogging of the arteries) leading to an early onset of peripheral vascular disease. Both of these clinical entities increase the risk of wound development and loss of limb. The loss of sensation, known as peripheral neuropathy essentially raises the individuals’ pain threshold so that they will either have a delayed reaction to an injury, or at the extreme, feel no pain whatsoever. Let’s examine the responses of an individual with impaired sensation versus another with normal sensation, both wearing shoes with a defect in the innersole producing excessive friction. Our normal subject would experience pain within 2 minutes of putting the shoes on, and would remove them to find an area which was slightly irritated, but the skin unbroken. Our neuropathic walker could conceivably complete his half hour walk before noting some mild discomfort. Upon removing his shoes he might find blistering, or a frank break in the integrity of the skin. Your physician can determine if your protective sensation has been impacted through the use of a simple kit, known as the Semmes Weinstein monofilament test. This kit was originally developed to test the level of protective sensation in patients suffering with Hansen’s disease (aka leprosy) who are also subject to neuropathy. The kit consists of flexible plastic monofilaments of differing diameter, the ability to perceive the touch of the smaller diameter fibers (with eyes closed) measures an individual’s ability to respond to painful stimuli. Fortunately, with tight control of blood sugars it is possible to avoid or delay the onset of diabetic neuropathy. If this information has been helpful then I will attempt to cover the issues associated with impaired blood flow to the extremities in my next post.

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