What is Peripheral Neuropathy?

Our nervous system comprises a complex network of nerves fibers that sends out and receives signals from other structures of the body. This signal exchange is vital for regulatory, defense and overall homeostasis of the body.

The nervous system is generally composed of two major parts: The central nervous system which consists of the brain and spinal cord, and the peripheral nervous system which involves any nerves outside the central nervous system.

The central nervous system functions as the main processor of the whole nervous system and controls all bodily functions. The peripheral nerves on the other hand have two segments. One segment sends out nerve signals from the brain and spinal cord to the muscles, organs and other bodily structures. The other segment sends back signals from the joints, skin and other organs back to the central nervous system. 

What is peripheral neuropathy?

Peripheral neuropathy is a disorder of peripheral nerves and does not involve the spinal cord and brain. There are several causes that can damage the peripheral nerves like cancer, vitamin deficiency,  alchololism and many more.

The most common cause of peripheral neuropathy is diabetes. Diabetic neuropathy is a major concern because it mainly involves legs and feet. 50% of all foot amputations are due to this condition.

How does diabetic neuropathy occur?

Our nerves and blood vessels work hand in hand to function properly. The blood vessels supply nourishment to the nerves and the nerves give out signals to the brain whether to increase or decrease blood flow to a certain area of the body. In diabetes mellitus, the blood vessels especially the small distal blood vessels get obstructed, minimizing blood flow, this is called microvasculinization. This causes the nerves to malfunction and fail to send important sensory messages to the brain.

Of all the structures of the body, the foot is most prone to this condition because it is most distal to the heart. Decreased sensory function on the foot is dangerous and can be fatal if not treated properly.

First of all, small cuts or blisters could not be felt by a patient with neuropathy of the foot. Since there is minimal blood supply to the foot, there is delayed would healing. This will cause opportunistic bacterium that normally live on the skin to flourish and can infect the wound without the patient knowing it. And since diabetics have high sugar content in the blood, this is a perfect medium for bacterial growth and can lead to septicemia. Septicemia is a life threatening condition where a bacterium are able to penetrate and live within the circulatory system, overwhelming the body’s immune system.

Heel Spur Symptoms and Treatment

A heel spur is a bony formation located at the calcaneous bone or heel bone that can clearly be seen through x-ray. Also called calcaneal spur, this condition is commonly associated with plantar fasciitis when the spur is located at the inferior aspect or at the bottom of the calcaneous bone. 

Though these conditions are related, they are two different disease entities. Plantar fasciitis refers to the irritation or inflammation of the plantar fascia, and a spur usually forms because of this. But not all patients with plantar fasciitis develop a heel spur and not all patients with heel spurs have plantar fasciitis.

Heel spurs are common in patients who suffer from chronic heel pain due to an inflamed plantar fascia. This is often seen on middle aged men and women or among active athletic individuals involved in sports like runners, basketball players and volleyball players.

Patients do not actually complain of heel pain due to heel spurs but from pain due to plantar fasciitis. Most often, a heel spur can only be found or diagnosed through radiological findings where the pointy bony prominence is located at the attachment of the plantar fascia.

How do heel spurs form? About 70% of patients with plantar fasciitis will develop heel spurs. The plantar fascia, which is located at the bottom of the foot, is a strong fibrous tissue that attaches to the heel bone to the balls of the foot.  It is responsible for the arch of the foot and plays a major role in the biomechanics of the foot. This fascia is also constantly under tremendous stress when walking, running or bearing weight.

However, this important structure is very prone to injury and degenerative changes. The natural wear and tear of this tendon can cause irritations and inflammation causing chronic heel pain. For some reason, the new bone growth is formed at the attachment of the plantar fascia to the heel bone probably because of the constant stressful pulling action.

Treating pain associated with heel spurs and plantar fasciitis can be done conservatively. Most often, the R.I.C.E. method which stands for rest, ice, compress, and elevate can effectively relive pain. Other treatments are foot inserts, pain medications and steroid injections. 

A new treatment called ESWT uses multiple shock waves to naturally stimulate healing in the injured fascia. This is a holistic approach since it encourages the own healing properties of the body.

For more information about heel spurs and plantar fasciitis, please visit the Family Foot and Leg Center in Naples or Contact Dr. Kevin Lam at (239) 430-3668.

What is Gout?

Gout is a common type of arthritis characterized by sudden attacks of burning pain, reddening, swelling and warm/heat felt from the affected area. About 50% of gout cases affect the big toe, though it can also affects other joints like the ankle, this areas are a major concern since ankle or heel pain can be debilitating and can affect a patients well being. Gout is a chronic condition and pain can occur on and off without prior warnings or signs. If not properly treated, this can damage joints, tendons and the surrounding tissues.    

The cause of gout is due increased amounts of circulating uric acid in the blood. This blood uric acid overload or hyperurecemia, produces sharp pointy urate crystals that can deposit in the joints and can form into large lumps causing severe pain. The urate crystals can form in other organs as well especially in the kidneys and can lead to kidney stone formation or renal failure due to urate deposits in filtering tubules. 

There are about 5 million Americans affected by gout. Men are nine times more prone to gout than women. In men, attacks of gout start from puberty. In women, it usually starts after menopause.

The risk factors involving gout formation are:

·         Obesity

·         Increase alcohol intake

·         Hypertension

·         Renal or kidney dysfunction

·         Increased intake of purine rich foods (anchovies, canned good, processed meats)

·         Certain medications: diuretics, anti-TB drugs, aspirin

The signs and symptoms of gouty arthritis involve the four classic signs of inflammation: 

·         Calor – warmness or heat felt in the inflamed area

·         Dolor- pain and tenderness

·         Rubor – redness

·         Tumor – swelling

Fever is also a symptom gouty arthritis that usually occurs in acute attacks.

High suspicion of gouty arthritis involves a history of joint pains especially in the toes. Strangely, gout pain always involves one joint at a time as compared to multiple joint pains in other arthritic conditions. Finding urate crystals on joint fluids by needle aspiration is the mainstay for diagnosing gout.

Gout can also be helped by gout supplements particularly those containing wild cherry.

Family Foot and Leg Center in Naples, FL offers holistic approaches on treating gouty arthritis involving the big toe or ankle. Contact Dr. Kevin Lam at (239) 430-3668 for more details.

What's Causing Your Heel Pain

When we walk, we put a lot of stress on each foot. Our feet can actually manage heavy loads but too much stress can push them to their limits. When you’re involved in sports like running, playing basketball or volleyball and even using the wrong shoes can irritate tissues in the foot that can lead to heel pain.

When the tissues around the heel get irritated, this will cause considerable amount pain on the affected area. This can heal itself without any medication if the foot is allowed to rest. However, a lot of people ignore the early signs of heel pain and go on with their usual activities. This can eventually lead to chronic heel pain that will need one or more treatment modalities to alleviate pain.

Diagnosing the cause of heel pain is best done by a podiatrist. Identifying the cause is crucial because there may be different or similar treatment options for each condition.

Generally, there are two categories in the diagnosis of heel pain. These are posterior heel pain or pain at the back of the heel and inferior heel pain or pain underneath the foot.

Posterior heel pain usual involves the insertion of the Achilles tendon to the calcaneus or heel bone. This is common among runners or in people who wear shoes that can apply pressure at the back of the foot. This initially starts are as tolerable pain and can get worse if ignored.

Inferior heel pain usually involves an irritated plantar fascia. The plantar fascia is a strong fibrous tissue found underneath the foot. Same as the Achilles tendon, the plantar fascia also inserts to the heel bone to the digits of the feet. The plantar fascia is constantly under pressure when walking, running, or lifting weights. It also plays a vital role in maintaining the arch of the foot. Plantar fasciitis is the term used for an inflamed or irritated plantar fascia. Irritation occurs at the insertion of the plantar fascia to the heel bone. In chronic plantar fasciitis, it is common to find a heel spur on radiologic findings.

Treatment involves the R.I.C.E method, which stands for rest, ice, compress, and elevate. This is very effective in the early course of heel pain. On the other hand, chronic heel pain is more difficult to manage especially when a spur has already formed. It is best to visit a podiatrist when dealing with chronic pain.