Peripheral neuropathy describes damage to your peripheral nerves, the nerves in your hands & feet. Damage to these nerves interrupts the important sensory information pathway between the limbs and the brain, resulting in changes to what you feel. While nerve damage can affect any part of the body, in the lower limbs the primary cause for neuropathy is diabetes.

What causes neuropathy?

In diabetes, it is the prolonged exposure to high levels of blood sugar that result in nerve damage. It is estimated that almost half of people with diabetes will develop neuropathy. Other causes of neuropathy can include:

• Nerve injury

• Infection

• Alcoholism

• Systemic conditions, autoimmune and other diseases

• Exposure to toxins

• Side-effects of particular medications

• Poor nutrition and vitamin deficiency

What are the symptoms?

The symptoms of peripheral neuropathy come on gradually and worsen over time. They affect the feet and toes and can include:

• Numbness

• Tingling

• Burning

• Pins and needles

• Reduced ability to detect hot and cold sensations

• Pain

• Muscle weakness

• Impaired reflexes

• Absence of sensation

Any interference with the ability to feel places the affected person at an increased risk of complications such as infection and ulceration.

How is it treated?

Because damage to the nerves is generally irreversible, it’s all about managing the symptoms, preventing their onset if possible and delaying their progression once they start. With diabetes, this is done by keeping your blood sugar in check and maintaining a healthy and active lifestyle.

It’s also important to take care of the symptoms that neuropathy is having on your feet. If you’re experiencing numbness that is limiting your ability to detect any cuts or wounds, a daily check of your feet will greatly reduce your risk of infection and complications. Other safety measures you can take include:

• Checking your feet daily

• Wearing shoes outside the house and slippers inside the house

• Staying aware of any new or unusual symptoms (to report to your foot specialist and GP)

• Wearing good, comfortable shoes

• Keeping your feet clean

• Being careful when cutting toenails to not accidentally damage the skin

• Managing any other conditions that affect sensation, such as callus and dry skin

If you do notice anything abnormal, it’s important that you report it to us at Reflex Foot Care and your GP. We perform annual foot screenings that assess your sensation. This must be done regularly due to the progressive nature of neuropathy, so you stay aware of all of your risks and how to best manage them.

Some medications can assist in reducing the symptoms and exercises may be prescribed to improve function, stability and strength.

How to care for your feet, if you have Diabetes

• Check for cuts, blisters, redness, swelling or any nail problems. If you can't see your feet close up then ask a family member to inspect for you, or use a magnifying hand mirror to look at the bottom of your feet. Call your Foot Health Professional (that's me!) if you notice anything that shouldn't be there!

• Keep your feet clean by washing them in lukewarm water, never hot water as you may scald them - use the temperature you would use for a newborn baby! Use a soft flannel or sponge and dry them by blotting or patting, take extra care between your toes!

What is Athlete’s Foot

• Athlete’s foot is a fungal infection of the skin. It generally leads to intense itching, cracked, blistered or peeling skin, redness and scaling
  
• It occurs on moist, waterlogged skin, usually between the fourth and fifth toes, or on dry, flaky skin
  

• Large painful fissures can also develop. The condition can also spread along all five toes and sometimes to the soles of the feet if left untreated

What causes it?

• It is caused by a number of fungal species that you can pick up from someone else shedding affected skin (typically in communal areas such as swimming pools, showers and changing rooms) or anywhere you walk around barefoot
  

• Athlete’s foot can also be passed on directly from person to person contact, although people who sweat more tend to be more prone to infection
  

• Once your feet have been contaminated, the warm, dark and sweaty environment of feet in shoes or trainers provides the ideal breeding ground for the fungus
  

• However, athlete’s foot also occurs in dry, flaky areas. It’s quite common in summer with sandal wearers. The sun makes your skin dry out so it loses its natural protective oils. This combined with the constant trauma from sandals makes your feet more prone to infection

So, who can get it?

• It’s not called athlete’s foot for nothing! Walking barefoot around swimming pools and spending your life in trainers may make you more likely to pick it up, but you do not need to be an athlete to get this condition

Is it serious?

• If left untreated, the fungus can spread to the toe nails, causing thickening and yellowing of the nail, which is much harder to treat
  

• Fungal infections are highly contagious and can spread to anywhere on your skin – including your scalp, hands and even your groin
  

• This is especially likely if you use the same towel for your feet as for the rest of your body. It is always best to treat this condition as soon as symptoms are first noticed

What are the treatments?

For athlete’s foot where the skin conditions are dry.. 

• If the condition occurs on a dry area such as your heel, you need to restore moisture by rubbing in an anti-fungal cream or spray, sometimes combined with a steroid cream
  

• You must remember to wash your hands thoroughly afterwards, or use disposable gloves so you don’t get the fungus on your hands

For athlete’s foot where the skin conditions are moist..

• Wash your feet in water as cold as you can bear (hot water only makes your feet fungus-friendly) then dry them thoroughly with a separate towel or even kitchen roll
  

• It is important to dab your feet dry rather than rub them, as rubbing tends to take away any healing skin
  

• Although the skin may appear flaky and dry, never use moisturiser between your toes, and avoid powders as they can cake up and irritate skin
  

• A spirit-based preparation such as surgical spirit can help (it’s cooling, soothing and antiseptic). Yes it can sting a little but will evaporate the moisture and allow the skin to heal. Only use on unbroken skin!

In severe cases, an anti-fungal tablet may be prescribed. However, tablets are not suitable for everyone, for example pregnant women, so always check with your pharmacist and follow the instructions carefully

You should also avoid using anti-fungal powders between the toes, although they are useful for dusting inside your shoes and trainers

The mistake most people make is to stop their hygiene regime, shoe rotation and/or medication once their symptoms have gone

Although symptoms may disappear after several days or weeks of treatment, the fungus can lie dormant and could eventually reappear in the right environment

Also, be alert to symptoms so that you can deal with any problems straight away

Fungal nails 

• Prescribed oral medications from your GP can be used for fungal nails. These usually take between three and six months to get rid of the infection but can take longer
• In the first instance, visit your foot specialist to discuss treatment options for Athlete's Foot or Fungal Nails
• There are several effective treatments for fungal nail infections ranging from sprays and lacquers to fenestration (The Lacuna Method) and microwave therapy! 
  

How can I prevent it?

The most important tip for preventing athlete’s foot and fungal nail infections!

Ensure your feet are completely dry after washing them and before you put your shoes and socks on

However, there are many things you can do to make your feet less hospitable to fungal infections

1. Are your shoes fitting comfortably? If they're so tight that your toes are squished together, this encourages moisture to gather up between your toes and really makes for the perfect environment for fungus. Instead, opt for a wider, deeper toe box (yes I know I harp on about toe boxes!) as it really does help air to circulate around your toes. 
   
2. Change your footwear on a regular basis! There's really no point treating your feet if you are unwittingly re-infecting them into damp, fungal infected shoes. It takes around 24-48 hours for your footwear to dry out, so alternating daily is recommended
3. Change your socks every day and wash them on a sixty degree wash. Even better is to buy cheap socks and replace them every three months (still wash and change of course)
   
4. Take out the insoles if possible and loosen any laces to fully open the shoes as much as possible so the air can circulate
   
5. If you do really have to wear the same pair every day, dry them out with a hair dryer, but use the cold setting. This will get rid of perspiration quickly without creating more heat
6. Choose shoes made from natural materials
   
7. If you wear trainers, choose ones with ventilation holes
8. Wear flip-flops in the bathroom/shower room and in public showers at the gym or swimming pool. This limits shedding skin around for other people to pick up and prevents you picking up any other type of fungus, or verrucae! (gross, I know)

“When should I see a foot specialist?”

• Athlete’s foot can usually be treated at home, but I may help you pinpoint the best treatment for your particular type of athlete’s foot. I can also help if the fungal infection has spread to your nails by performing a fungal nail test to identify if you do indeed have a fungal nail infection. Also reducing the thickness and cutting back of the nails, exposing the infected nail bed to a lighter, cooler environment

• Even though nail infections can be treated with oral medications, they can have side-effects. If you have other medical conditions or are on other medication, your GP may recommend that you don’t take oral meds

Below, I have supplied some information about fenestration which is a successful treatment for fungal nail infection!

                                                                                           Thank you for reading!
                                                                                                                   Hayley :-)