Clinical Manifestations and Current Treatment Options for Diabetic Neuropathies

Carolina M. Casellini, MD; Aaron I. Vinik, MD, PhD, FCP, MACP


Endocr Pract. 2007;13(5):550-566. 

In This Article

Whereas small-fiber neuropathy presents as different forms of pain, large-fiber neuropathy is manifested by reduced vibration perception and position sense, weakness and muscle wasting, and depressed deep-tendon reflexes. Diabetic patients with large-fiber neuropathies are uncoordinated and ataxic and are 17-times more likely to fall than their nonneuropathic counterparts.[95] It is important, therefore, to improve strength and balance in patients with large-fiber neuropathy. Patients can benefit from high-intensity strength training by increasing muscle strength, improving coordination and balance, and thus reducing falls and fracture risks.[96] Low-impact activities such as Pilates, yoga, and tai chi—which emphasize muscular strength and coordination and challenge the vestibular system—may also be particularly helpful. In addition, options to prevent and correct foot deformities are available such as orthotics, surgery, and reconstruction.

Basic management of small-fiber neuropathies by the patient should be encouraged. These are as follows: foot protection and ulcer prevention by wearing padded socks; daily foot inspection using a mirror to examine the soles of the feet; selection of proper footwear; scrutiny of shoes for the presence of foreign objects; and avoidance of sun-heated surfaces, hot bath water, or sleeping with feet in front of fireplaces or heaters. Patient education should reinforce these strategies and, additionally, discourage soaking feet in water. Education will also promote foot care by encouraging use of emollient creams to help skin retain moisture and to prevent cracking and infection.


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