There are two types of nerves that may be affected: small nerve fibers, and large nerve fibers. Small nerve fiber damage will cause abnormal sensation and large nerve fiber damage leads to decreasing sensory perception and coordination. Damage to these nerves can be caused for several reasons, but the most common is diabetes. The progression of the neuropathy is highly dependent on the glucose levels in the blood, though the exact mechanism of damage is still unknown.



In uncontrolled or undetected diabetes, there are abnormally high levels of glucose or "sugar" in the blood. The abnormal levels of glucose causes multiple problems in your body including, eye, kidney, and cardiovascular damage. Often, the first problem noticed is the atypical sensations in the feet caused by peripheral neuropathy or nerve dysfunction. The symptoms are progressive and start at your toes and move up like a sock. Diabetic patients often complain of tingling, burning, numbness sensations, similar to the sensations a person feels when their foot "falls asleep."

Over time, the damage will lead to complete loss in sensation. This is the leading cause for diabetic foot ulcerations. A person with lost foot sensation still has motor (muscle) function and can continue to walk, but they are unable to detect sores or pain. Unknown sores on the feet combined with other diabetic complications leads to ulcers (open sores) and sometimes amputations.

To assess your peripheral nerve function, a podiatric physician can do several basic screening tests. While the patient's eyes are closed, the podiatric physician uses several tools to test the small and large fiber nerves in the foot. Such tools consist of a Semmes Weinstein Monofilament (similar to fishing line), tuning fork, and a Q-tip. It is such a simple screen and takes only five minutes to perform, so, there is no excuse for diabetics or pre-diabetics not to get tested. Early detection of neuropathy can greatly decrease its progression and protect the feet from ulcers, infections, and even amputations.

Diabetes is one of the leading causes of death in the United States and the complications associated with the disease can greatly impede on a person's quality of life. It is important to prevent and detect diabetes early to avoid and slow down the debilitating damage of the high glucose levels in the blood. Diabetes has a great effect on a person's feet and often shows some of the first signs of diabetic complications. Thus, one with diabetes or diabetic risk factors should pay close attention to their feet and contact their podiatric physician.