PART 4: WHY DO MY TOES, ANKLES AND FEET HURT AT NIGHT? DIABETIC FOOT DISEASE

Over the past month, I have discussed why venous and arterial disease as well as Raynaud’s Syndrome may cause pain in the feet and toes at night. Today, I want to discuss another one of the most common causes I see in my clinic for pain in the feet at night: Diabetic foot disease.

Interestingly, diabetes mellitus has Greek etiology and literally means sweet (mellitus) urine (diabetes).  Diabetes is a condition in which the body loses its ability to limit the amount of sugar in the blood.  The high concentrations of sugar result in the formation of harmful chemicals that can hurt the eyes, kidneys, and nerves all around the body, especially in the feet.  Once the sugar levels become high enough, they overload the kidneys—the organ that creates urine—and sugar overflows into the urine, hence the Greek etiology of diabetes mellitus.

Diabetes causes pain in the feet via two main pathways: Neuropathic pain and pain from ulcers. 

Neuropathic Pain:

For neuropathic pain, the high blood sugar levels damage the small nerves in the feet responsible for sensation.  As a result, patients often complain of burning, cramping, tingling, and at the very worst end of the spectrum, numbness.  Sometimes only the toes have these symptoms, but often times the symptoms can encompass the entire foot!

Ulcerative Pain:

The way diabetes results in the formation of ulcers is multifactorial.

  • First, the damage to the nerves can result in numbness or lack of sensation.  Thus, when a person injures their foot, that person does not feel it and protects it from further injury.
  • Second, in addition to damaging the nerves responsible for sensation, diabetes also damages the nerves that innervate muscles responsible for moving.  The damage to the muscle nerves occurs in such a way that irregular contractions of muscles within the foot push the bones of the foot outward creating pressure points that ulcerate easily.  Once the ulcer is formed, infection of the ulcer or exposure of the raw tissues beneath the skin can cause pain.  In patients who otherwise have numb feet, an infection can spread to an area that does have sensation and cause pain there.

Given that diabetes is so common, patient education is vitally important to those impacted by this disease.  If you or anyone you love suffers from diabetes, my hope is that this blog will help you to better understand some of the underlying factors that may be contributing to your foot pain at night.  As a rule of thumb, always remember to share with your primary care physicians all symptoms of pain that you experience during your regularly scheduled appointments and if you think your condition may be getting worse, please do not hesitate to call my office to schedule an appointment for a second opinion! We can help.

408-376-3626

Dr. Ignatius H. Lau

Vascular Surgeon

Dr. Ignatius Lau grew up in Portland, Oregon. He attended the University of Washington in Seattle for college and Stony Brook University in Long Island for medical school. He then went on to train in vascular surgery at Mount Sinai Hospital in New York City. During his time in New York, he performed over 1600 cases involving aortic, peripheral, venous, and carotid surgery. He has a special interest in limb salvage and treating patients with peripheral arterial disease and has extensive training and experience in treating the full spectrum of vascular diseases. Dr Lau was also very active in medical research during his training, ultimately finishing with twelve peer reviewed manuscripts. During his training in New York he met his wife, Lisa, who is a practicing endodontist. Together they love to hike, try new restaurants, and travel.

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WOUND CARE EXPERTS IN SAN JOSE; NON-HEALING LEG OR ANKLE WOUNDS

Leg and foot wounds have become a huge problem in the United States. Fortunately, there are thousands of Wound Care Centers to help with the day to day care of these painful and potentially dangerous wounds. Wound care centers are usually affiliated with hospitals and function as one of many resources that a patients with wounds has at their disposal in an effort to keep their wounds from progressing to where amputation may be the only choice left to salvage the limb. Unfortunately, in many of these wound care centers an underlying cause for why many of these non-healing wounds don’t heal in a timely manner is often overlooked: circulation to the leg or foot. This can be either on the arterial side (Delivering oxygen and nutrients necessary to heal the affected area) or on the venous sid​e, (Removing toxins and fluid from the affected area).

Research has shown that about 70% of people who seek care at Wound Care Centers have an underlying circulation issue. Unfortunately, the current practice in most wound care centers is that this circulatory problem is not diagnosed or considered until after months of futile debridement and dressing changes have failed to achieve long term healing. In an effort to best treat non-healing leg wounds it is critical, therefore, for patients to have their circulation evaluated by a Vascular Surgeon.

This is even more important in patients over the age of 50, if there has EVER been a history of smoking, diabetes, or hypertension.

Finally, this evaluation must be done at the very start of a wound care patients treatment and not be put off until after debridement and other topical approaches have failed. If you or a loved one is currently being seen at a wound care center for non-healing leg wound it is vital that you insist upon getting a vascular ultrasound study if it has not already been done.

Testing for circulation is a non-invasive process and can be done, in most cases, in under an hour. Testing is pain free and does not involve the use of any drugs and or anesthesia. Using simple sound waves a Registered Vascular Ultrasonographer can easily scan for circulatory deficiencies and provide your physician with the critical information they need to develop a plan for how to best approach healing your wounds.

Non-healing leg wounds and ulcers fall into several different categories:

Diabetic Wounds: If you have diabetes, you may be prone to foot ulcers since you may not have protective sensation on your feet. Causes of foot ulcers include excessive pressure or rubbing against the skin that may result from wearing ill-fitting shoes or walking barefoot.

Arterial Wounds: Complete or partial arterial blockage can lead to ulcers. If you have arterial disease, you may have tests to measure blood flow or to locate a blockage in your arteries.

Venous Wounds: These ulcers are usually a symptom of venous disease, where the veins in your legs are compromised, causing blood to build up. Typical venous ulcers appear near the ankle and are often painful.

South Bay Vascular Center and Vein Institute, with offices in both Campbell and Gilroy, CA. specializes in the treatment of Non-healing leg and foot wounds. Led by Dr. Polyxene Kokinos, MD. RPVI. South Bay Vascular Center Physicians are world class experts in revascularization techniques that can help re-establish blood flow to areas suffering from circulatory illness. Recognized as an expert in her field, Dr. Kokinos teaches advanced revascularization techniques to local vascular surgeons looking to offer similar care to their patients. If you or anyone you know suffers from non-healing leg or foot wounds, call today at 408-376-3626 to schedule your appointment.

WE OFFER HOPE WHEN OTHERS SAY THERE IS NONE!