Questions and Answers About Neuropathy

Q. What is neuropathy?
A. Diabetic neuropathy is actually a group of nerve diseases affecting the nerves to the limbs—beyond the brain and spinal cord. All three types of peripheral nerves may be affected: motor, sensory, and autonomic.

• Motor nerve fibers carry signals to muscles, and motor neuropathy can cause muscle weakness and unbalanced forces on joints. This can cause hammer toes, bunions, and other foot deformities.
• Sensory nerves take messages from the extremities to the brain, including information about pressure, pain, or potential injury. Symptoms of sensory neuropathy include loss of feeling or abnormal sensations, such as prickling, tingling, burning, aching, sharp pain, or pain in toes or feet.
• Autonomic nerves, which are not consciously controlled, affect heart rate, blood pressure, and controlling of sweating and skin glands. People with diabetic neuropathy can have dry skin that cracks easily.

Q. What treatments are available for the condition?
A. At present, there are no effective medications that reverse the nerve damage of diabetic neuropathy, but there are treatments that may improve some of the symptoms of neuropathy. Good foot care is especially important and early treatment when a problem is detected is critical. Also, those with neuropathy may have to avoid weight bearing exercise, like walking or running, or use special shoes or orthotics.

Q. Can neuropathy be prevented?
A. Yes, at least in some cases. Good control of blood sugar appears to be helpful. One scientific study, the Diabetes Control and Complications Trial, studied complications in people with tight glucose control and those using regular diabetes treatment. Only one-third as many people in the tight-control group developed neuropathy compared to those in the standard-treatment group. Also, careful blood glucose control may even heal some of the early changes of neuropathy. Avoiding alcohol and cigarettes may help protect nerves from damage, as well.

Q. I was told my veins are refluxing (opening and closing improperly) causing a burning pain in the back of my thighs. I feel this burning mostly when I menstruate and occasionally when I do a lot of walking. I was told surgery might help. Could this be PAD and if so what should I do?
A. This is not PAD (peripheral arterial disease). Your veins return blood from your legs to your heart. Vein reflux means the valves, which help return blood, are not working correctly and leak. This is a relatively common problem in the superficial system of the veins in the legs and is associated with varicose veins. The deep veins may also reflux, which is more serious and may occur after deep venous thromboses (blood clots in the leg veins). The association with the menstrual cycle may indicate a condition called pelvic congestion syndrome, which can be associated with refluxing veins in the pelvic veins and can be associated with varicose veins.

Pain in the back of the thighs is an unusual location for pain due to venous problems. It would be important to be absolutely sure that your symptoms are related to the pain in the back of the thighs before having surgery. It would be important to see a certified vascular surgeon in your area, particularly one who is a member of a major national society such as the American Venous Forum or the American Association for Vascular Surgery, societies which are linked from our web site, at www.vdf.org.

If you have a question you would like our panel of experts to address in our next newsletter, please send it to info@vdf.org or The Vascular Disease Foundation, 3333 S. Wadsworth, Suite B-104-37, Lakewood, CO, 80227.