Neuropathy, peripheral - Complications of peripheral neuropathy

Peripheral neuropathy can sometimes cause other medical problems.

These vary depending on the underlying cause of the condition, and can include foot ulcers and disturbances to the blood circulation and heartbeat.

Diabetic foot ulcer

A diabetic foot ulcer is an open wound or sore on the skin that is slow to heal. These are common in people with diabetic polyneuropathy.

If you have numb feet, it is easy to cut your foot by treading on something sharp.

An ulcer can also occur if you unknowingly develop a blister caused by badly fitting shoes. If you do not feel any pain, you may continue walking without protecting the blister. If the cut or blister gets worse, it may develop into an ulcer.

High blood sugar can damage your blood vessels, causing the blood supply to your feet to become restricted. A reduced blood supply to the skin on your feet means it receives a lower number of infection-fighting cells, which can mean wounds take longer to heal and can lead to gangrene.

Gangrene

If you do develop a wound infection in one of your feet as a result of peripheral neuropathy, there is a risk this could lead to gangrene (death of part of the skin or underlying tissues).

If gangrene does develop, you may need surgery to remove the damaged tissue (known as debridement) and antibiotics to treat any underlying infection, and in severe cases your toe or foot may need to be amputated.

If you have diabetes, you should take extra care of your feet. Get your feet checked regularly by a podiatrist (a medical professional, also known as a chiropodist, who specialises in foot care).

Read more about preventing gangrene and taking care of your feet.

Cardiovascular autonomic neuropathy (CAN)

Cardiovascular autonomic neuropathy (CAN) is another potentially serious problem that is common in people with diabetic polyneuropathy.

CAN occurs when damage to the peripheral nerves disrupts the automatic functions that control your blood circulation and heartbeat.

The two main noticeable symptoms of CAN are an inability to exercise for more than a very short period of time and orthostatic hypotension (a type of low blood pressure that can make you feel dizzy or faint when you stand up).

Treating CAN

You may be able to control the symptoms of orthostatic hypotension by using a number of self care techniques, such as:

• standing or sitting up slowly and gradually
• drinking plenty of fluids to increase the volume of your blood and raise your blood pressure
• wearing compression stockings to help prevent blood falling back down into your legs
• tilting your bed by raising it at the head end

In some cases, medication may be required to treat orthostatic hypotension. Two widely used medications are fludrocortisone, which works by increasing the volume of your blood, and midodrine, which works by tightening your blood vessels.

A more serious concern with CAN is that your heart may suddenly develop an abnormal pattern of beating (arrhythmia), which could lead to a cardiac arrest, where your heart stops beating altogether.

To prevent this, you may be prescribed medication to help regulate the beating of your heart, such as flecainide, beta-blockers or amiodarone.

If you have CAN, you will probably need to have regular check-ups so your heart function can be monitored.