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Posts for: September, 2015

  Peripheral neuropathy, as we have spoken about before, is a gradual degenertaion or deterioration of the nerves, especially the small nerves of the feet.  It is most commonly seen in people with diabetes, but there are many other causes as well.  This can include idiopathic (where there is an unknown underlying cause, but many things have been ruled out), as a result of chemotherapy for cancer, vitamin deficiency (especially B12, although Thiamine and other vitamin deficiencies can also be to blame), heavy metal toxicity (mercury, lead, and even arsenic), and several others.  No matter what the cause of the neuropathy, the result is often the same.  There is usually numbness, tingling, pins and needles sensations, paresthesias (crawling sensations or other feelings of things that are not there), burning pain, sharp shooting electrical shocks, muscle abnormalities (causing hammertoes, change in muscle tone, muscle wasting, etc.), and autonomic changes (decrease in sweating, dry skin, discoloration, cold or hot feeling, etc.).  A person may have NONE or ALL of these findings.  Much of this will depend on how long the problem has been present (Diabetics, for example, may show no changes or have no symptoms at first, but the longer they are diabetic, the more of these problems may present themselves).  

   Once the diagnosis of peripheral neuropathy is confirmed, there are a number of treatment options.  Many drugs can be used to treat the symptoms of peripheral neuropathy.  The problem with drugs is that they just treat SYMPTOMS.  For the most part, these reduce the pain and burning, but really do little or nothing for the numbness or lask of sensation, which can be worse for the patient in the long run.  Narcotic medication is often the worst, because in addition to just masking the pain, the patient can suffer from sedation and constipation, and can, and often does, become addicted to the narcotic.  

     There are a number of vitamins that can help, and often help quite a bit, not only with the pain and burning of neuropathy, but also with the numbness and tingling that occurs.  These vitamins, in some cases, can actually result in the growth of new small nerve fibers within the skin.  One of these that has shown great promise is alpha lipoic acid.  Taking up to 600mg of this vitamin, up to three times per day, has often been shown to be beneficial in treating neuropathy in the diabetic patient, and the non-diabetic as well.  A lower dose is often advised to start with, and many pharmacies sell the vitamin in as low as 100mg.  B vitamins, such as B6, B9, and B12 have also shown beneficial effects in treating neuropathy.  A prescription medical food, known as Metanx, can also be prescribed if the over the counter vitamin therapies are not working.  One must understand, that none of these vitamin therapies will show results quickly.  A month is often the minimum amount of time needed to see any change at all, and in many cases it may take 2-3 months to see a significant improvement.  The advantage to using these vitamin therapies is that there are typically NO side effects, little or no drug interactions, and often the cost is significantly less.  In many cases, the beneficial effects of these can be measured OBJECTIVELY using an ENFD - or epidermal nerve fiber density test.  This is a skin biopsy, usually done just above the ankle, to measure how many nerve fibers are present within the epidermis (the outer layer of the skin) BEFORE the vitamins are prescribed, and can be repeated  AFTER (usually six months) treatment has been started.  This can often show a significant increase in the number or density of nerve fibers.

     In an upcoming blog, we will be talking about the use of LASER for peripheral neuropathy, another NON-INVASIVE treatment that is showing great results for a number of people with peripheral neuropathy.


Richard S. Eby, DPM

7348 East Brainerd Road

Chattanooga, TN.  37421

(423) 760-3115

September 04, 2015
Category: Heel Treatments

  YES!  It is true.  There is a very good chance that if you have plantar fasciitis - the very bad pain on the bottom of the heel that starts hurting in the morning and acts up whenever you sit down and get back up on it - your pain will probably get better if you lose a little weight!  Now - by no means am I saying that ALL people with heel pain are overweight.  There are people who are very thin that have heel pain.  But the vast majority of people with pain on the bottom of the heel will see at least some pain relief, and many will see a LOT of relief, by losing a little weight.

   Plantar fasciitis is caused by a tightening of the ligament on the bottom of the foot that runs from the heel to the base of the toes.  When it becomes painful, it is due to a chronic inflammation, and sometimes small tears within that ligament or fascia.  Anything that causes more pressure on the foot - sports activities, long periods of walking or standing, flat feet, very high arch feet with weight concentrated on the heel, and excess weight - can make it worse.  While people of normal weight DO get heel pain, a large number of people where this condition is long-standing and very difficult to treat are...well...LARGE.  I once saw a woman get a single steroid injection into her heel, lose just 10 pounds (and the woman was just very slightly overweight to start) go for 14 YEARS without pain.  The really odd thing is that when she came back to me for a second injection, she said she had recently gained that weight back.  I've seen people have gastric bypass surgery after having uncontrolled diabetes, cardiovascular disease, AND heel pain - where after several unsuccessful to slightly successful treatments for heel pain LOST 80 to 100 pounds (and these were BIG people to start)...see their heel pain resolve COMPLETELY, the need for diabetic medication go WAY down or even eliminated.  Of course their blood pressure many times stabilizes as well.

A few years ago I bought an old house and decided I would "rehab" it.  That's basically fixing it up, and in my case spending more money on the supplies and labor than I did on the house!  To keep expenses from getting totally out of hand, I agreed to pick up some of the materials needed at Lowe's and Home Depot, and have them ready for the contractor to put in.  I have knee arthritis, so going up and down the 20 or so stairs at the front of the house was no fun anyway.  But just carrying cans of paint up those steps caused my knee pain to become excruciating.  If that wasn't bad enough, carrying kitchen cabinets up was even worse.  A few extra pounds made a hug difference in my knee pain, and it does the same to the heel.   

   Not every one will see heel pain resolve completely as a result of losing weight, but if you or someone you love has had heel pain for a year or more, it has not responded well to treatment, and you may just be carrying around a few extra pounds, give it a try!   Losing a little weight may just make a BIG difference in your level of pain.


Richard S. Eby, DPM


7348 East Brainerd Road

Chattanooga, TN.  37421