Foot Pain in Diabetes is commonly due to neuropathy.
Neuropathic pain in diabetes- It may cause burning or sharp pains in feet and interfere with your sleep. Painful diabetic foot neuropathy may occur in combination with a loss of sensation.
Diabetic neuropathic pain can present with either of the below conditions-
- Altered sensory symptoms like tingling sensation
- Burning pain
- Electric shock like shooting pains down the legs
- Cramp like sensations in the legs
- Knife like pains
- Increased sensitivity walking barefoot on sand or marbles or on contact of clothes
- Achy pain legs and feet
- Sensations of heat or cold
MANAGEMENT-
Differentiating neuropathic pain from other common causes of foot pain is essential.
Controlling sugars- Most of neuropathic pain in starting stages of diabetes gets controlled with sugar level maintenance.
Vitamin B12 deficiency- can present with neuropathic pain, in patients with normal biothesiometry or mild neuropathy supplementing methylcobalamin will control these symptoms.
Biothesiometry – Levels above 25v in VPT suggest severe neuropathy and methylcobalamin supplementation would not be sufficient, these cases on adding drugs like tricyclic antidepressants, SNRI drugs like duloxetine, anticonvulsants, and opiates will control the symptoms.
Poor blood flow to foot- lead to claudicating pain typically presents after walking for a period at calf or thigh level depending upon location of occlusion of blood vessel supplying lower limb, these require drugs to improve circulation, angioplasty or peripheral bypass.
Unilateral electric shock like shooting pains from thigh to down the legs should arouse a suspicion that the pain may be due to lumbosacral nerve root compression. Should evaluate by taking MRI lumbosacral spine and treat nerve compression by physiotherapy or surgical decompression.
Edema and pain- patients with pedal swelling on hanging legs down leads to compression of nerves at tarsal tunnel level and neuropathic pain distal to it, this condition may not improve with medications, in these cases surgical decompression of tarsal tunnel is required.
Varicose veins and leg pain- engorged pain on prolonged walking with aching pain in legs, these gets relieved with using compression stockings.
