PERIPHERAL NEUROPATHY
Peripheral neuropathy is a peripheral nerve damage. The role of peripheral nerves is to send informations from brain and spinal cord, i.e. from central nervous system to all other body parts and back. Nerves that can be affected by peripheral neuropathy are:
- sensory nerves responsible for sensation control
- motor nerves responsible for muscle control
- autonomic nerves responsible for body systems control
Depending on the number of nerves that are affected there are: mononeuropathy (single nerve damage), multiple mononeuropathy (damage of two or more nerves) and polyneuropahty (multiple nerves are damaged at the same time all over the body).
Signs and symptoms of peripheral neuropathy may include numbness and gradual burning sensation in feet and hands, tingling, sharp pain, extreme sensitivity to touch, lack of coordination, weakness or muscle paralysis etc..
The most common cause of mononeuropathy is physical injury caused by prolonged pressure on the nerve that runs close to the body surface along bone (wrist, elbow, shoulder, knee). Also, nerves my be damaged during stressful activity, prolonged exposure to cold or heat and during radiotherapy.
Some peripheral nerves are prone because they are located on exposed place (median, ulnar, radial and peroneal nerve). Pressing the peroneal nerve located superficially at the top of the lower leg, muscles that raise foot become weak causing foot drop.
RHEUMATOID ARTHRITIS
Rheumatoid arthritis is a chronic disease of the joints accompanied by inflammation, swelling, pain and function loss. The process begins in the synovial membrane that secretes synovial fluid which lubricates joints. Synovial membrane also provides nutrients and oxygen for cartilage made of collagen that lines the end of bones.
When inflammatory process takes over synovial membrane, it destroys collagen and joint space decrease. Pannus that damages and destroys cartilage and bones that are characteristic for progressive stage of rheumatoid arthritis, is formed by creating connective and granulation tissue.
All joint can be affected, including the small joints of the spine. Morning stiffness, pain and swelling are common symptoms. As the disease progresses, symptoms are more pronounced, movement limitations occurs, joint instability, deformity, degeneration and muscle weakness.
TROPICAL ULCER
Tropical ulcer develops as a result of ishemic necrosis and ulceration of the skin, but it can also affect deep tissue. First, lesions appear as papules (hard bumps with diameter less than 1 cm) at the lower leg, usually at injury area. Soon they spread and form pustules (pus filled blisters) that will turn to necrosis.
Ulcer is accompanied by pain, fever and malaise. Within few weeks, ulcer increases and develops superficial stinking black coat with pus.
Sometimes it can be cured spontaneously, but in some cases it may result with deep lesions that penetrate muscles, tendons and bones. Untreated ulcer can result in scarring and disability.
DIABETIC FOOT
Diabetes is a metabolic disease in which person has high blood sugar, either because insulin production is inadequate or because the body’s cells do not respond properly to insulin. Due to reduction of sugar amount in the cells and higher amount in circulating blood, numerous tissue and organ damage are formed which can be divided into: angiopathy (vascular damage) and neuropahty (nerve damage). Diabetic foot occurs as a result of insufficient blood circulation and nerve damage.
As feet carry on a whole body weight, they are very sensitive to changes in blood vessels and nerves that can cause a numerous problems on toes, heels and foot arches. Symptoms include changes in skin color and cold feet, redness, dryness, pain, tingeling, nail changes and others.
Charcot foot represent specific form of diabetic foot condition characterized by changes in bone relations in tarsometatarsal part. Changes in bone relations cause lowering the foot arch leading to a change of position and creating calluses. Callus represent soft tissue injury which due to vascular and nerve damage, doesn’t heal. Very soon wound appears which rapidly gets infected and tropic ulcer occurs who may lead to necrosis and gangrene. Infection and gangrene cause destruction of soft tissue with bone osteolysis and after that, it follows amputation of toes, part or all foot.
It is very important to prevent diabetic foot with procedures as: regular washing, wiping with soft towel, careful and proper nail clipping, application of special creams and wearing comfortable shoes. There are special socks for diabetics with weft fibers to improve blood circulation and orthopaedist recommend custom made orthopedic shoes.
