Neuropathy

According to Tabers Medical Dictionary, Neuropathy means any disease of the nerves. Motor neuropathy causes muscle weakness and sensory neuropathy diminishes sensation. Understanding of the sensory component is critical since it is an important mechanism for protection. Sensory feedback normally provides for an early warning system. When sensation is impaired, the part of the body that is affected loses its ability to interpret external stimuli that may cause harm. The ability to distinguish between hot and cold, dull and sharp and pressure and pain are compromised. In more severe neuropathies, people have been known to walk on fractures without their awareness. It is not uncommon to hear of sharp objects, such as carpet tacks, thorns, glass, or other sharp objects embedded in the foot of someone with significant loss of sensation without their knowledge. In such cases, it is necessary to inspect the feet carefully on a daily basis. The use of protective footwear is also highly recommended.

Neuropathy can also affect proprioception. Proprioception involves the awareness of the body or body parts in space. This includes posture, movement, changes in equilibrium and position sense. If the proprioceptors are affected, then the knowledge and position of where your foot and ankle are in space may be impaired. The common compensation is the utilization of visual cues by looking down at the foot and ankle during ambulation. In certain cases, there may be a denial or neglect of the involved body part or vision itself can be affected.

Each person with neuropathy is affected in different ways. Some people go through a lifetime with very few symptoms, while others experience mild to severe symptoms. A variety of symptoms have been reported including paresthesia (a tingling, pricking creeping sensation on the skin) and muscle cramps particularly in cold weather. Neuralgia or pain along a nerve pathway may be present. Pain may be deep or superficial. Burning or electric shock sensations may be present along with spasms or tremors.

Skin is one of our body's most protective organs. It is the first line of defense from many hazardous elements in the environment. Once a wound is present, the second line of defense takes place. The body sends extra circulation and white blood cells to help heal and fight any bacteria that may exist. The presence of neuropathies presents additional considerations. How soon was the wound recognized? Are there any foreign objects (splinter, glass, nail, etc) still in the wound? Has an infection already started? Has the cause of the wound been determined and eliminated? Are there any fractures? How long will it take to heal? People with neuropathies tend to heal slower and have more complications.

Infections can be minor to severe. Most infections are treatable. Every infection should be taken seriously. Immediate wound care will minimize the risk of infection. People with neuropathies are more prone to infections since open wounds take longer to heal. The longer a wound remains open, the longer the immune system has to fight the infection. Severe infections sometimes require hospitalization and continuous IV antibiotics.

Wounds and injuries are most often preventable. As neuropathies become apparent, subtle but important changes in habits can go a long way in protection and prevention. Recognition is the first step in prevention. Further adaptations or solutions may be needed to improve one's protection if the neuropathy progresses. Calluses or blisters are early warning signs of underlying biomechanical problems. Advanced warning signs include the changing shape of your feet and ankles. Additional indicators include an increased tolerance to pain. Due to diminished sensation, there may be a higher tolerance to pain. Trauma that would normally cause a great deal of pain may be minimal. It is essential to heed these warning signs as they can lead to serious complications later on.

Neuropathy often causes the lower limbs to change shape. Muscle mass is affected and joint deformities can result. Muscle mass decreases due to the inability of the nerve to conduct the proper signals. This is called atrophy. As the muscles weaken one side of a joint, the opposite muscle becomes overpowering causing a muscle imbalance. The greater the deformity, the greater the internal stresses are on ligaments, tendons, joints, and muscles. This is true on the outer surfaces on the skin as well. The pattern and progression of specific deformities often describe specific pathologies. In such cases, future deformities are predictable. These deformities, in conjunction with impaired protective sensation, can lead to dangerous situations. They must be recognized and prevented. If patterns of deformity are predictable, they should be preventable.

In order to correct and prevent deformity while promoting efficient ambulation, an orthotic support system must offer dynamic function and triplanar control. Bracing systems that do not apply triplanar control for improved mechanics and reduction of internal and external pressures should be avoided. Examples of such devices are common and include conventional polypropylene and double upright metal and leather designs. The bracing system should employ remodeling techniques to reduce "fixed" or limited deformities until the deformity has been corrected. Accommodative orthotic techniques and systems have been utilized for many pathologies as the standard treatment for deformity over the years. We believe this is the wrong long-term treatment plan because it does not prevent the progression of deformities. These devices ultimately become part of the problem rather than providing solutions.

Neuropathy cannot be cured but the results must be addressed and solutions sought in order to maintain efficient gait that is balanced and safe. Existing deformities must be corrected and future deformities must be prevented. This is our goal at DynamicBracingSolutions™.