Here is a typical scenario that I am presented on frequent basis.  A patient has been given the diagnosis ofperipheral neuropathy –either from their primary care physician or more likely a neurologist. They often bring to the visit a voluminous amount of testing material that they have undergone-nerve tests, MRI’s and blood tests. Many have questions and others are frankly fearful. It’s pretty common for “well meaning friends and relatives” to have related some horror story about a person they know who had a catastrophic complication from peripheral neuropathy. Something like this: they heard from friend who has a distant cousin who was told that they had neuropathy now has wound up in a wheelchair.

What to do-first relax and take a deep breath!  The first thing to do get more information from the person who diagnosed you with the condition- doctors are notoriously good at ordering tests but sometimes fall short in explaining the results. In deed the terminology associated with peripheral neuropathy can be quite intimidating-words like polyneuropathy, demyelinating disease, delayed latency and my favorite- chronic Inflammatory demyelinating polyneuropathy (CIDP).

My suggestion is to get a basic understanding about neuropathy by logging onto to some popular websites explains the condition in easy-to understand terminology. To name just a few: National Institutes of Health, Mayo Clinic and Wikipedia. My website-footpaincenter.com contains many articles on peripheral neuropathy along with frequently asked questions. Having armed yourself with knowledge, a consultation with your doctor will be a lot more beneficial. Make sure to ask questions during your visit-if you don’t understand something -make him or her explain it in terms that you understand.

The most pressing concern that patients express to me when they are told that they have peripheral neuropathy are what are the treatments for peripheral neuropathy. Unfortunately there is no real cure for neuropathy-but there are number treatments that help reduce neuropathy discomfort and can slow down the progression of the condition. Gabapentin (Neurontin) and pregabalin (Lyrica) are commonly prescribed medications for neuropathy. They may not effective as they claim to be in relieving neuropathy symptoms and there are many side-effects. If your doctor prescribes these meds- ask questions about his experience on its effectiveness-and put a time limit on taking these drugs. For example after taking these medications for three months –and you had no relief from pain, burning and tingling-you might ask him to take you off these meds. An important note-always inform your doctor if you decide to stop taking any medication. Neurontin and Lyrica are anti-seizure medications and it could be dangerous if  you abruptly stop.

There are many other treatments options as well for neuropathy including vitamin and nutritional supplements, laser therapy, infrared therapy, topical creams and patches, hyperbaric oxygen, pain medication, spinal stimulators and immunogloblin therapy and Botox® injections.

I hate to be trite- but knowledge is indeed power when dealing with peripheral  neuropathy.

Peripheral neuropathy is a “double-edge” sword. People with neuropathy experience severe discomfort in their feet-pain, burning and numbness. These uncomfortable sensations are difficult to bear. Add a second component, balance problems, and you have one heck of a challenging condition. In fact over 75% of neuropathy sufferers have some degree of balance difficulties.

There are three key factors in maintaining balance-the eyes, inner ear and of course the feet. Peripheral neuropathy is nerve damage to the small nerves supplying the feet, affects the ability to sense the ground-this sensation is called proprioception.  Poor balance invariably translates to falling. There are lots of scary statistics about the dangers of falling-especially as we get older. I will skip the gruesome figures-suffice it to say that falls can cause severe injury, loss of mobility and reliance and dependence on others.

What can you do to improve balance? Unfortunately there is no silver bullet. Improving balance takes time, practice and patience. Here are some practical suggestions:

• Purchase a balance video-balance exercises should be part of your daily routine. “Pop in” a video into your DVD or computer and follow along with the video. Repetition and consistency will help strengthen key muscle groups which help to gradually improve balance. Where to get a good balance video?-You can search on the internet-just type in-balance video. I am in the process of creating a video on improving balance in conjunction with a balance specialist.
• Many disciplines are particularly in improving balance-Tai Chi for example is an eastern discipline that focuses on slow, deliberate movements. Pilates and modified yoga techniques are excellent ways to improve balance.
• Daily activities such as walking and swimming tone lower extremity muscle groups which in turn will improve balance.

When starting an exercise or balance program –here are a few things to keep in mind-Make sure that you are wearing comfortable walking shoes. A good walking shoe will have built-in arch support. Make sure that the heel is well padded and the toe area is well rounded-to prevent blister or corns. I discourage wearing exaggerated rocker-soles. This type of shoe is very popular of late.  A rocker-sole has is highly angulated on the bottom-front portion of the shoe. This creates a “rocking motion” when walking. This creates an unstable surface when walking which impairs balance and can cause falls.

Walking aids such canes, walkers and walking poles is often met by resistance by people who need them the most. Improving balance is a slow process and the key is to remain active. Walking aids allow a person with poor balance to participate in everyday activities. This in turn will strengthen muscles and build confidence when walking.

Picture a carnival setting-with a salesman standing in front of a crowd-touting his “miracle product.” He claims that his potion-medicine-concoction-whatever you call it-will cure a plethora of conditions. To name just a few-it can cure baldness, arthritis, stomach problems and boost your energy. We laugh at this stereotypical huckster-yet sadly this scenario is seen much too frequently in the field of peripheral neuropathy.

I have written about false neuropathy claims in the past but the actions of unscrupulous  people–playing on the desperation  of people with neuropathy-continues to irk me. Let’s face it-neuropathy is a tough condition to live with. The constant burning, tingling and electric shock sensations in the feet are extremely uncomfortable. It can make nighttime a literal nightmare-as many people have difficulty falling asleep. The numbness is another matter-if you can’t feel your feet-you are prone to injury, blisters, infections and worse-possibly amputation (particularly if you are diabetic). Then there is the balance and waking problems-people with peripheral neuropathy invariably experience walking difficulties-since the nerves in the feet send faulty nerve impulses to the brain.

Traditional medical approaches in treating neuropathy can work to alleviate some of the discomfort. There are many conventional treatments that are effective. To name just a few:

• Medications such as Neurontin and Lyrica
• Infrared therapy
• Laser therapy
• Nutritional supplements such as Vitamin B6 and B12, alpha lipoic acid, turmeric and acetyl-l-carntine
• Hyberbaric oxygen therapy
• Physical therapy treatments including electrical stimulation, massage therapy and ionotophresis
• Acupuncture
• Topical patches, creams and solutions including Lidoderm Patches, Nerve Health Relief Cream, Neuragen and Capsaicin

To improve balance there are a number of options-balance classes, lower extremity muscle strengthening, Tai Chi, shoes with built-in stabilizing mechanisms such as a roll-bar® heel available in New Balance Shoes, and mild rocker-bottom-soles available by Mephisto Shoe Company.

These are viable solutions option. Treatments can take time to be effective-for example adding beneficial nutritional supplement can take from six months up to a year to see positive results. In other instances there is a degree of trial-and error to determine which therapies and medications are beneficial. Since there is no one” home-run” cure for peripheral neuropathy-this opens the playing field for the charlatans of the world, playing on people’s desperation.

One famous ploy frequently used and advertised in local newspapers goes like this: “the miracle cure that doctors don’t want you to know about.” Fortunately for you this brilliant individual has the cure that will solve all your neuropathy problems. Sounds too good to be true-well of course it is absolutely false! Think about this claim-why would any health care professional hide an effective cure for neuropathy.  The fact is they wouldn’t withhold an effective treatment for any medical condition.

These unscrupulous individuals are playing on people’s desperation for a cure-My admonition-don’t fall for it.  Do your homework-find a good reputable health care fractioned and please have reasonable and realistic expectations when seeking treatment for peripheral neuropathy.

We often comb through health magazines and articles to find effective ways to keep us healthy and fight certain diseases. Some regimens may be quite involved and complicated. Here is a simple solution that you only need to travel to your spice rack in your kitchen. I am talking about called turmeric. Turmeric is a culinary spice, frequently used in Indian curries. Used as a both medicine and food for centuries, scientific studies are indicating that turmeric is a promising nutritional supplement that is effective in treating many disease processes.

The National Institutes of Health lists 24 current studies on the effects of turmeric-which is closely related to the spice ginger. These studies suggest that turmeric (the active ingredient of this spice is called curcumin), has many beneficial health properties. The numerous studies indicate that turmeric has a wide variety of medical uses which are attributed to anti tumor, antioxidant, anti-arthritic, anti-ischemic and anti-inflammatory properties.

As an anti-ischemic agent, turmeric can help increase blood supply to the peripheral nerves. Lack of blood circulation to the nerves in the feet and the hands are known contributing factors for causing peripheral neuropathy. Turmeric also acts as an anti-inflammatory which is a contributory cause of peripheral neuropathy and diabetic neuropathy. A recent article the American Pain Management Journal links peripheral pain to small fiber nerve inflammation small nerve fiber inflammation. Researchers have found that turmeric works by inhibiting several different molecules that are involved inflammation including COX-02 (Celebrex® is a prescription Cox-2 inhibitor), nitric oxide and prostaglandins. As a natural ingredient turmeric is safe and non-toxic.

Neuropathy pain, known as neuropathic pain, does not always translate as pain per se.  Many people with peripheral and diabetic neuropathy describe neuropathy as burning, tingling, numbness, electric shocks, numbness or “pins and needle sensations.” Studies, attributed to its antioxidant properties, have shown that turmeric is a natural pain reliever-which can be effective in treating the discomfort of neuropathy.

Besides benefiting people with peripheral neuropathy, turmeric can be helpful in a variety of other medical conditions including:

• Turmeric is a powerful anti-inflammatory that has been shown to relieve pain for osteoarthritis and rheumatoid arthritis.
• Numerous studies of turmeric indicate that this spice can prevent the onset of Alzheimer’s disease
• A study at Kansas State University Research Department indicated that turmeric can help prevent certain cancers

• A study from the University of South Dakota indicates that pre-treatment with turmeric makes cancer cells more vulnerable to chemotherapy and radiation therapy
• Animal studies at the University of Texas indicate that turmeric inhibits the growth of skin cancer-melanoma and also slows the spread of breast cancer into the lungs.
• Turmeric seems to delay liver damage that can eventually lead to cirrhosis

Safety of Turmeric

Turmeric is a safe food spice that has been used especially in India for thousands of years. Contraindications: Turmeric should not be used by people with gallstones or bile obstruction. Though turmeric is often used by pregnant women, it is important to consult with a doctor before doing so as turmeric can be a uterine stimulant.

The best ways to get turmeric in your diet

As a seasoning on foods:

You can add turmeric spice to a wide variety of Asian dishes like Thai and Indian curry and Malaysian and Indonesian style dishes. It can also be added to your morning omelets. Another excellent way to ingest turmeric is through various tea blends.

Turmeric capsules:

Oral turmeric capsules are an easy way to obtain your daily source of this beneficial spice. Common daily dosages range between 400mg and 500 mg.

There is an old expression: ” you are what you eat.”  As a practicing podiatrist for the past 35 years I can attest that this statement holds for the feet as well. The foods,  vitamins and nutritional supplements that we ingest (and the lack of these substances) can have a pronounced effect on our over-all general health.

Here’s a sampling of foot conditions affected by nutrition and diet:

Gout – Once known as a “rich man’s disease” since it was associated with kings and statesmen, gout is an extremely painful condition often seen in the great toe joint, caused by high levels of uric acid.  High levels of uric acid can precipitate into the joints and the kidneys A gout attack frequently affects the great toe joint-causing severe pain, redness, heat and inflammation. Along with proper medication, gout can be controlled by a low purine diet. People with gout should limit their intake of meat, seafood, and dried legumes.

Osteoporosis – This is a condition in which the bones become fragile and more likely to break.  Your feet alone contain 52 bones!  Fractures anywhere are painful; in larger joints and the spine, they can also be devastating .Post menopausal women are particularly prone to osteopenia and osteoporosis.  Adequate levels of calcium needed for healthy bones can be obtained through diet (milk, cheese and yogurt) and calcium supplements.  Vitamin D and daily servings of fruits and vegetables can be helpful as well.

Peripheral Neuropathy – This condition, caused by damage to the nerves, resulting in pain, numbness, tingling and burning in the feet. There are over 50 causes of peripheral neuropathy-some directly attributable to nutrition. Diabetes one of the common causes of neuropathy is due to in ability to metabolize sugars.   Lack of Vitamin B-especially Vitamin B6, B12 and Folic Acid can cause peripheral neuropathy. Here are some healthy foods that contain high sources of Vitamin B: Wild salmon, organic cheese, organic chicken and organic turkey.  Alpha-Lipoic acid, a powerful antioxidant, is used in Europe as a primary treatment for neuropathy. Alpha lipoic acid is a fatty acid that is made naturally in the body. Foods that contain alpha lipoic acid include, broccoli, spinach, liver, steak and yeast.

Diabetes-Diabetes is a lifelong (chronic) disease in which there are high levels of sugar in the blood. Diabetes can affect many organs in the body-with feet, kidneys and eyes being most prevalent. A diabetes is a healthy-eating plan that is naturally rich in nutrients and low in fat and calories. Recommended foods include healthy carbohydrates-fruits, vegetables, whole grains, legumes (beans, peas and lentils). Mayo Clinic recommends fiber-rich foods such as whole-wheat flour and wheat bran and heart-healthy fish-cod, tuna and halibut. “Good fats” containing monosaturated and polysaturated fats can help lower cholesterol-avocados, almonds, pecans,walnuts, olives, canola oil, olive oil and peanut oils. Foods to avoid include saturated fats (high-fat dairy products and animal protein-hot dogs sausage and bacon),trans fats (processed snacks and baked goods) and cholesterol (egg yolks, shellfish  and liver).

Always check with your physician before making dietary changes or adding new vitamins; some supplements may interact unfavorably with prescription medications.

Botox is the most commonly administered cosmetic treatment in the world. Cosmetic injections help reduce and eliminate frown lines, crow’s feet and other facial wrinkles. There are many other medical uses for Botox other than cosmetic. Botox is medically indicated for the treatment of urinary incontinence, headaches excessive sweating (called hyperhidrosis) and certain neurological conditions causing muscle spasticity. Recent studies and clinical trials are now being conducted for the treatment of peripheral neuropathy and diabetic neuropathy pain (referred to as neuropathic pain).

Botox is actually a toxin that selectively “paralyzes” or relaxes certain muscle groups in the body.  Recent experimental evidence suggests that Botox (botulinum toxin type A), inhibits the release of a chemical called acetycholine which in turn helps reduce pain sensation in the small muscle fibers supplying the feet and the hands.

A recent clinical study at New York University School of Medicine suggests that Botox can provide pain relief for several types of neuropathy including diabetic neuropathy. Further studies around the world also substantiate this premise.  Similar studies were conducted in France and Canada with similar conclusions: Botox can help reduce chronic neuropathy pain.

These studies are very encouraging for those who suffer from neuropathy pain and discomfort-including burning, numbness and “pins and needles” sensations. Unfortunately some of the medications used today for treating neuropathic pain have a low success rate with many associated side effects. Neurontin and Lyrica, the most commonly prescribed medications for neuropathy have less than a 50% success rate in reducing symptoms of neuropathy-along with many side-effects.

A personal story

“My balance problems started about five years ago. At first I occasionally lost my balance especially at night when going to the bathroom. It seems every year it gets worse. At this point I almost dread walking for fear that I might fall. Going shopping is a nightmare-there are so many people and there is nothing to hold on to. My grown children bought me a walker and I use it sometimes but I wish I was steadier when walking.”

Why balance is a problem for those with neuropathy and what to do about it

Dr. Marc Spitz, director of Footpaincenter.com, answers

There are many causes of balance problems-to name just a few: Inner ear problems, stroke, “mini stroke (TIA), brain or spinal cord injuries, tumors or other neurological disorders. The reason that balance problems are associated with neuropathy is due to damage of the small nerve fibers that the supply feet and toes.

The brain which is bodies’ computer processes the data received from the nerves throughout the body.  Without the proper input from the nerves the feet do not receive proper messages from the brain. The result is lack of proprioception-the ability to sense where the feet are positioned relative to the ground. Lack of proprioception translates to poor balance.

Improving balance

There of ways to improve balance and as important-keeping the leg and foot muscles toned so that they do not atrophy or become weaker-which would cause additional balance problems.

• Exercise programs–Walking or biking (this includes the stationary bicycle)
• Tai Chi-an eastern discipline that promotes balance
• Water activities including swimming and water aerobics
• Shoes that promote balance-many walking shoes have mild rocker incorporated into the shoe. A rocker sole tilts upwards at the toe which contributes to a heel-to-toe gait as opposed to a side-to-side gait.  I strongly discourage an exaggerated rocker sole which was all the rage a few months back. This type of sole actually causes instability which walking even more difficult. Some walking/athletic shoes such as New Balance have a built-in roll bar for added stability.
• Waking aids-canes and walkers-some people are resistant to using such devices. I recommend the use of walking devices when balance is so severe that a person would be in danger of falling. I have seen devastating falls which resulted in injuries such a broken hips.
• Foot and leg braces- some people have collapsed arches or they drag their feet (referred to drop-foot). The newly designed foot or leg braces can significantly stabilize the foot and leg ankle when walking.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), approximately 60 to 70 percent of people with diabetes have some form of neuropathy. Peripheral neuropathy is not an exclusive condition of diabetes. Over 23 million American have neuropathy and a large majority of them do not have diabetes. There are many causes including nutritional deficiency, lower back problems, thyroid condition, post chemotherapy, inherited conditions and auto-immune diseases. In approximately 50% of the cases, the cause is unknown which is called idiopathic. Many of these patients are treated by a wide variety of prescription medications including a variety of medications including Neurontin (gabapentin), Lyrica and Cymbalta. These medications may be effective in relieving neuropathic pain; however there are many reported side-effects which may make them difficult to tolerate. For example, side effects for commonly prescribed anticonvulsant drugs include drowsiness, trouble concentrating, confusion and weight gain. Many patients with neuropathy have existing medical problems and are already taking other medications. Many of these patients are resistant to taking even more medications and are often seeking other treatment alternatives.

 Iontophoresis

Iontophoreses is non-invasive method of delivering medication using a small electric current that drives the medications through the skin into the underlying tissue including the nerves. When taken orally as noted, Neurontin can cause uncomfortable and even dangerous side effects. Using Neuontin in an iontophoreses treatment, much less of the drug is needed to be effective. There are precautions when using this type of treatment including:

• Cardiac pacemakers or other electrically sensitive implanted devices
• Known sensitivity or adverse reaction to the drugs to be administered
• Known adverse reactions to the application of electrical current
• The skin patches should not be used on damaged skin or recent scar tissue
• Ionotophoresis should not be used during pregnancy

Where can you get iontophoreses treatment?

Iontophoreses is frequently used by physical therapists in the treatment of a variety of conditions including injury, tendonitis, arthritis and plantar fasciitis. Different medications are used for iontophoreses-depending on the medical problem.  Cortisone and anti-inflammatory medications are used for arthritis whereas for plantar fasciitis, acetic acid (white vinegar is commonly used. At the Foot Pain Center in Seal Beach, California, iontophoreses is frequently used in the treatment of peripheral neuropathy. If you are under the care of health care professional for neuropathy, I suggest that you ask him or her for prescription iontophoreses therapy.

What causes painful, numb and burning feet?

With neuropathy getting more media attention—let’s separate fact from fiction.  The condition is due to damage to the nerves supplying the feet.  Diabetes is a major cause, yet there are over 15 other factors attributed to causing neuropathy. Some of these include post chemotherapy treatments and adverse reactions to some medications such as high doses of antibiotics and statin drugs to lower cholesterol. Lower spinal problems such as narrowing of the spinal cord, called stenosis, can lead to numbness burning and muscle weakness in the feet and legs.  Other causes of neuropathy include exposure to certain toxins –lead or arsenic, alcoholism, HIV/AIDS, autoimmune diseases (rheumatoid arthritis and lupus) and poor circulation. In some instances neuropathy can be inherited as with Charcot-Marie Tooth disease.  Surprisingly in over 50% of the cases of peripheral neuropathy, the exact cause is unknown, called idiopathic polyneuropathy.

Let’s dispel a few myths with our fact our fiction quiz:

Fact or fiction

All diabetics develop neuropathy—fiction. About 50% will experience neuropathy.

“I’ve read about and amazing cure for neuropathy”—fiction. There is no one cure for the condition and it often takes a combination of treatments to help ease symptoms.

Neuropathy is on the rise—Fact.  20 million people suffer from neuropathy and the numbers are increasing annually.