Oh, My Aching, Cracking Feet!

Pinpointing neuropathy symptoms can be a challenge

Joy Pape By Joy Pape, RN, BSN, CDE, WOCN, CFCN

When it comes to feet, we receive the most questions about lots of "funny" feelings associated with people's feet. You and I both know it's not so funny, but that's how I think of neuropathy. Why funny? Because neuropathy shows up in so many different ways, some people just say, "My hands and feet feel so funny, it's hard to explain." Many times the symptoms of neuropathy are hard to describe.

Just like everybody is different, and everybody's diabetes is different, so is neuropathy. There are even different types of neuropathy. If this is a concern to you, plan ahead to talk with your health care provider so you can better explain your particular symptoms and get some relief

So what is neuropathy? Our dLife dictionary defines neuropathy as a "disease of the nervous system. The three major forms in people with diabetes are peripheral neuropathy, autonomic neuropathy and mononeuropathy. The most common form is peripheral neuropathy, which affects mainly the legs and feet."

Can neuropathy be prevented? The good news is we think so. How? By managing your blood glucose numbers to as near normal numbers as you possibly can. The bad news is, we can't guarantee this, but it is your best bet.

It's always good to get a second opinion, so this month I asked Jimmy Bennett, Registered Pharmacist, Certified Diabetes Educator to help me answer some of your questions.

First of all, Jimmy recommends people talk with their health care professional about their symptoms and get their problem(s) diagnosed. Symptoms of diabetes neuropathy can be the same as other problems, but with very different causes. For example, foot pain and dry skin can be caused by heart and circulation problems, underlying nerve problems, or by diabetes. Each would be treated somewhat differently. Once diagnosed, you and your health care provider can better work together to find the treatment that is just right for you.

For everyone who has been diagnosed with diabetes, Jimmy recommends you ask your health care provider to perform a simple test called the monofilament test. "The monofilament test involves touching the bottom of the foot with what looks like a piece of stiff nylon fishing line. If you can't feel it when they tap the bottom of your foot or toe, then that may indicate a problem with the nerves that are in charge of the ‘feelings' in your feet." He also reminds us of the importance of good diabetes management because, "Neuropathy always gets worse if you don't get your blood sugars under control, so its important that you watch your daily blood sugars by using your meter and that you have an A1c test done to see if you are within the ADA target of less than 7% or the ACE target of below 6.5%."

Besides feeling funny, another symptom of neuropathy we get a lot of questions about is dry, cracking feet. Since elevated blood glucose levels usually causes dry skin, a simple start for safety and comfort is keeping your feet moisturized. Jimmy and I both recommend starting out with over-the-counter lotions and creams. Always start simple, and remember to apply it to your entire foot. Unless otherwise instructed by your health care provider, do not apply lotions or creams between your toes because the lotion will keep the area too moist and that invites fungal infections.

Some products can be very expensive, but for the most part, they don't need to be. Having the word "Diabetes" on the label may only make it more expensive. Diabetes management is costly enough. We like to help you look for ways to be nice to your pocketbook as well as your diabetes. If you're not sure which ones to try, talk with your pharmacist. He or she can recommend some good, inexpensive products for you to start out with. You may need to apply the lotion or cream several times a day. Wearing socks after applying your lotion or cream at bedtime helps hold the moisture in. This helps them feel oh so soft in the morning.

For those who don't get relief from just plain over-the-counter lotions or creams, Jimmy gives us some more advice for dry feet. "The urea contained in creams and lotions works in a unique manner to keep the skin soft. There are some generic brands but a couple of good brand names are Carmol and Dermal Therapy. Another good cream is Neoteric Diabetic Skin Care Cream. These rub in easily and leave your skin soft but not too greasy. You might also look for creams containing L Arginine. L Arginine has been studied and has shown some benefit in painful neuropathy."

As for treatment, Jimmy states there are new medications for the treatment of neuropathy. "The newest medicine is called Lyrica and has gotten good results in the patients who have tried it. It is important to get the right dose. Sometimes you have to start out on a low dose and slowly go up on the dose till you get some relief. There is another new medicine called Cymbalta that has proven to be of benefit. There is a nonprescription treatment called capsaicin that can be rubbed on. It must be applied four times daily for a number of days until it reaches its maximum effect."

So, when it comes to dry, itchy feet, remember…

  • Do your homework. Share as much information with your health care provider and get a diagnosis so you can get the correct treatment.
  • If you do have diabetes, ask your health care provider to perform a monofilament test.
  • Look at your feet daily.
  • Be aware of any changes. Identify the cause for the change you note.
  • Take appropriate actions. If your shoes were too tight, wear different shoes. If it's not better in 24 hours, call your health care provider.
  • Clean and dry your feet daily, using a gentle soap. Dry well between your toes
  • Moisturize at least daily with an over-the-counter moisturizer. If this doesn't help try using a product with urea/L Arginine or capsaicin.
  • Speak with your health care provider about new medications for neuropathy.
  • Most important…Keep your blood glucose numbers as normal as possible so you can be more comfortable and...


Read Joy's bio here.

Read more of Joy Pape's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

Last Modified Date: July 08, 2013

All content on dLife.com is created and reviewed in compliance with our editorial policy.

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by Brenda Bell
Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...
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