By the WoundSource Editors
Chronic wounds pose an ongoing challenge for clinicians, and there needs to be a clearer understanding of the pathophysiology of wound chronicity and treatment modalities available.
By Aletha Tippett MD
Every six minutes, somewhere in the United States, someone loses a limb due to amputation because of peripheral neuropathy. Neuropathy can cause pain, balance problems, loss of dexterity, and loss of sensation, all of which can lead to foot ulcers.
Peripheral neuropathy is the number one cause of foot ulcer related amputation in diabetics. More than 60% of diabetes mellitus patients will eventually develop this condition. More than 82,000 of diabetic patients will suffer the loss of a limb this year—the majority because of peripheral neuropathy. While there are other causes of peripheral neuropathy, such as medications, infections, especially mycobacteria, alcoholism, chemotherapy, toxins such as Agent Orange, vitamin deficiencies, and idiopathic, the main cause is diabetes. The neuropathy is the result of ischemic injury to the nerves plus poor glucose control.
Treatment for neuropathy is virtually non-existent other than good glucose control and pain management. Pain management includes antidepressants, anticonvulsants, topical medications, and pain medicines including opioids. The best opioid for neuropathy is methadone because of its affinity for the NMDA receptors in addition to mu opioid receptors. There are some treatments to reduce effects of neuropathy and slow or halt progression. These are not as widely known and include electrical stimulation and use of an active form of B-vitamins, Metanx. There are also some limited attempts at tarsal tunnel surgeries with some moderate success in reducing symptoms.
The most important thing for diabetics and others at risk for neuropathy is screening for the condition. A 10gm monofilament screening of the feet can easily be done in a few minutes. This test should be done yearly for all diabetics or anyone who tests positive. Once neuropathy is identified the patient can be counseled about close monitoring and examination of their feet (since they have loss of protective sensation, they must look), and any other controllable factors such as regulating blood glucose. Incredibly, if doctors would do this simple screening, and teach their patients how to do this, amputations could be reduced by 50%. What a simple, cost-effective way to improve outcomes and quality of life for many people.
The Hope of Healing Foundation®, dedicated to limb preservation and wound healing, sponsors free foot screenings at local health fairs, drawing hundreds of people for screening. For more information on how to receive a foot screening visit www.hopeofhealing.org or contact the foundation at 10274 Alliance Road, Cincinnati, Ohio, phone: (513) 891-3698.
About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.