By Dr. Conway McLean,

FAPWHc, DABFAS

ESCANABA — The numbers tell the truth, the years to come will see a continued rise in the number of Americans afflicted with diabetes. That and our aging population will have significant consequences to healthcare expenditures. Both of these issues can have serious repercussions when it comes to wellness and quality of life measures. And both can lead to nerve problems.

The term typically applied to the most common type of nerve dysfunction is neuropathy. Although the word is frequently encountered in the media, there is (as with so many things these days) considerable misunderstanding on this condition. Neuropathy is not a precise label, applying as it does to varying situations.

Many people who aren’t diabetics develop an impairment of the smaller nerves farthest from their core, usually referred to as idiopathic neuropathy. That word simply means we are uncertain why it developed. More common is the diabetic type, in which the inability to feel the pain of even minor skin trauma too often leads to infections and limb loss.

Several recent studies have brought to light another consequence of these nerve problems. Nerves have numerous functions in the human body, from detecting a skin injury to picking up a pencil, from maintenance of our oil glands in the skin of our feet to remembering last night’s dinner. Cognition, a rather scientific term for how well one thinks, can be affected by neuropathy.

Although it may not be obvious, nerves are critical to our ability to stand and walk, the vital functions of gait and stance. These are essential components of ADL’s, the activities of daily living, as well as being the best form of exercise for many. The research clearly indicates the reduced nerve function of neuropathy impairs our capacity for this vital task.

The interactions between the nerves in our feet, the brain, and the muscles utilized to stand is complex and multifaceted. Although it seems logical, the research clearly demonstrates impaired balance and stability in the presence of neuropathy. Those individuals afflicted with adult-onset diabetes will typically have some degree of the nerve dysfunction, making them prone to instability. The studies indicate that even relatively young people with diabetes may have impaired balance but certainly the greatest dangers occur to seniors.

Few of us are able to prevent the changes occurring to our tissues over time. These age-related declines in our reflexes, muscle strength, and ligament health, aren’t necessarily related only to neuropathy. But in combination with osteopenia, serve a predictable consequence. The result is that too often a fall leads to a broken bone. When it’s a larger bone, a blood clot can be produced that may travel to the lungs or the heart. This effect of a fall is not conducive to health and vitality. Some never are able to walk again and find themselves confined to a long term care facility.

An individual’s balance can be evaluated in a surprising number of ways, from precise measurements of muscle strength to the performance of specific movement studies. Several such tests exist, allowing us to measure someone’s ability to stand up or walk a specific distance. Another test evaluates how well someone can stand for a time in progressively more challenging positions.

Sensory nerve function can be determined, although few of these are truly objective measures, requiring the subject to experience some stimuli and then respond in some fashion. Unfortunately, these aren’t testing the nerve itself. Instead, this type of study involves a complex chain of events, starting with a nerve receptor being stimulated, then sending a signal to the brain. The appropriate part of the brain registers the signal, triggering awareness of the sensation. Finally, the individual verbalizes confirmation.

A very different method is now routinely being used to test for neuropathy, one that enables us to directly and very specifically measure and evaluate the health of microscopic sensory skin nerves. It was developed by Johns Hopkins University, whereby a tiny piece of skin from the side of the ankle is specially treated, allowing us to literally count how many of these structures are functioning.

Unfortunately, most people who develop neuropathy have no symptoms to alert them to its presence. Many assume they will experience the intense burning often described in ads. More often, a subtle numbness evolves, with little fanfare. Foot and joint positioning becomes masked, a mystery. Although it only makes sense, sufficient research has demonstrated a significant increase in instability and this in turn means there are more falls.

Various therapeutic approaches have been utilized to reduce these dangerous, often traumatic events. Physical therapy geared toward improved gait and stance, strengthening the muscles involved in these processes, is common. Improved nerve function is possible for many with nutraceutical therapies, although a delay in the diagnosis or treatment reduces the benefits.

Bracing is another technique wherein better physical support can help to stabilize the body. Even something as unobtrusive as custom in-shoe supports, aka foot orthotics, have been shown to aid in these efforts. Since falls often occur in the home, clearing your home of potential hazards can reduce the number of falls, by removing throw rugs and piled-up newspapers.

The combination of reduced muscle tone, nerve dysfunction, and impaired reflexes means that the risk of falling for an older person with type 2 diabetes is dramatically increased when compared to a healthy adult of similar age. The biggest issue is recognition since few individuals will seek out assistance for reducing their risk of falls, especially if the presence of neuropathy has not been made. If you are noticing some of the symptoms of instability, especially if you have diabetes, get an evaluation of your stance and gait, as well as your nerve function. You need to stay upright.

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Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with offices in Escanaba, Marquette, and L’Anse. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. His articles on health and wellness appear in multiple local and national publications. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.