Tuesday, 24 October 2017

Diabetic Peripheral Neuropathy

Scenario 1
Diabetes can progress and worsen, with nerve involvement in the limbs and digits. Without normal innervation to the digits, the feet and toes feel tingling sensation. The toes can feel when touched, rubbed or squeezed, but they are abnormal.

Scenario 2
In the Malay context, there is avoidance by mothers in the post-partum period (dalam tempoh pantang), not to walkabout and to remain in bed as much as possible. This is to avoid having mothers accidentally kicked the door frame, especially the raised door frame on the floor (bendul). Accidentally kicking the door frame (or the door itself) can cause serious injury to the toes involved. The mother does not feel the tingling sensation immediately, but much later, and for a long period, until the toes are put right by proper massage and stretching techniques. Ignoring the problem will cause the mother to experience extreme pain while walking for long periods. What can be done to alleviate such problem?

Is there hope
Can nerves in the foot be put right once there is tingling sensation? It depends on what happened and the level of severity. If the toes look normal colour and the nails are growing fine, there is some hope. Occasional massage is good to maintain and encourage blood flow. But will the nerves regenerate?

What can be done?

  1. Massage the toes to reduce pain sensation. Some LMS will help. Menthol relieves pain (minyak angin). Tea tree oil is quite useful as it has menthol and the oil is good for massage.
  2. Stretch Use the hands and flex the toes up towards the body, hold and then release. Repeat a few times. Then flex the toes towards the floor to see if they feel better.
  3. Wiggle the toes while watching TV.
  4. Massage the thigh by pulling action, pull them up towards the body. This is correct the nerve and blood vessels to the toes. 
  5. Massage the affected foot before sleep. Use some oil to massage the thigh inward and upward towards the body. Raise the affected foot when sleeping. This will relieve pain in the thigh and affected foot. The thigh and foot will correct itself in about 2 days if done correctly. 

Pain and tingling sensation will return once in a while. Constant massage of the foot will help to keep the pain away and keep the foot alive. Blood vessels can regenerate and form new ones. The toes will maintain normal colour if there is blood flow. Nerves are difficult to regenerate but there is hope that they will generate given the right environment. Something to ponder upon.

External links
http://www.endocrinologyadvisor.com/an-overview-of-diabetic-peripheral-neuropathy/slideshow/3770/

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