Peripheral neuropathy

Peripheral neuropathy occurs when the tiny blood vessels that supply the nerves become damaged and therefore do not supply the nutrients that are needed. This leads to the nerves deteriorating, with the extremities being affected first. 

Painful neuropathy of the hands and feet, with symptoms including numbness, burning or shooting pain, tingling and paraesthesia (pins and needles, particularly at night) affects a significant number of people with diabetes and can progress to persistent neuropathic pain.

Management usually involves amitriptyline, duloxetine, gabapentin or pregabalin, with tramadol used for acute rescue therapy and capsaicin cream an option for those preferring a topical treatment.

Diabetic foot problems stem from a combination of peripheral neuropathy and peripheral arterial disease. Loss of the nerve sensation that usually protects the foot and sometimes deformity (a condition known as Charcot foot) can lead to abnormal loading of the foot. Minor trauma such as injury or ill-fitting footwear, which may go unnoticed, can precipitate infection and ulceration. 

Diabetes UK says that 70,000-90,000 people with diabetes have a foot ulcer in any given week, and the condition leads to in excess of 8,500 toe, foot and leg amputations each year.

Annual foot checks are essential and should be brought forward if someone notices symptoms such as swelling, unusual warmth in one foot, a change in the shape or colour of the foot, or another issue to do with their feet.