Peripheral Neuropathy: Treatment is Like Finding a Needle in a Haystack

Do you know that feeling when your leg falls asleep?  Some people refer to this as pins and needles or burning.  If you suffer from peripheral neuropathy then you know this feeling all too well.  Imagine the end of the day thinking you finally get to relax and forget all about the stresses of work, kids, the economy, but when you begin to relax your feet or even your legs begin to burn or having that feeling like they are asleep.  Some people describe the feeling of bugs crawling on their legs.  Either way it is hard to relax with this going on.

“Neuropathy” means nerve damage.  My initial impression of how to treat peripheral neuropathy was rather simple.  Something injured the nerve, find it, fix it, and the nerve gets better, right?  Wrong!  Nerves are tricky, very complex, yet very sensitive to injury.  Some of the more common nerve injuries that are linked to peripheral neuropathy include compression such as a bulging disc in your low back or carpal tunnel syndrome in your wrist, infections such as HIV or hepatitis, organ failure such as kidney or liver disease, poor blood flow, diseases such as Diabetes or autoimmune conditions, many medicines and drugs especially alcohol, and even poor nutrition causing vitamin deficiencies.  Put it this way:  there are about 150 known causes of neuropathy, which means there are at least another 150 causes we have yet to discover.

Finding the cause is like looking for a needle in a haystack.  There are so many potential causes and they can overlap.  A patient can have Diabetes, low thyroid, and degenerative disc disease in their low back, all of which can cause nerve damage.  Which one are you going to blame for that burning, tingling, and numbness in your feet?  Well, we try to blame it on the cause that is treatable.  This patient in my example can control their Diabetes, take thyroid hormone supplement, and their back can be fixed.  What if the burning and tingling in their feet remains?  In that case we now call the nerve damage, “idiopathic neuropathy”.  Basically a big word that means we really have no idea what is causing this nerve damage.

The next option is to treat the symptoms of neuropathy and I’m sorry to say that pain medications (narcotics) do not work for neuropathy pain!  There are older treatments such as anti-depressants and newer derivatives such as Cymbalta.  We can use medications aimed at preventing seizures in low dose like Gabapentin or Pregabalin.  There are the often overlooked physical therapy treatments such as electrical stimulation, counter-irritants such as Capsaicin or Biofreeze.  The treatment grows like a pyramid with more specific and more complex treatments at the top.  Anything above what I have already mentioned would best be prescribed by a Neurologist.  That’s the nerve specialist.

So what’s the take home message about neuropathy?  See your doctor, don’t wait!  Since I am a podiatrist at Desert Foot Surgeons, I am often the first to see a patient about these nerve complaints.  The longer you wait, the more difficult it will be to fix.

Treatment of Hammertoes

hmrtoe2 Toes that are bent or buckled hurt when you put them into shoes. Parts of the toe can rub against shoes making areas of hard skin, known as corns. These can be reduced by your podiatrist, but will never resolve unless the toe is straightened. Changing the shoe to keep pressure off the toes might not be possible depending on how severe the toe is buckled.

The treatment differs based on the stiffness of the bent toe. Smaller toes such as the 4th or 5th that can be straightened by hand often can be treated by simple tendon release. This is the easiest hammertoe surgery to recovery from often requiring a single stitch. If more than one toe is done at a time the recovery can be slightly longer.


If the bend in the toe cannot be straightened by hand, removal of the rigid joint is performed. At Geller Podiatry we employ a detailed step-wise approach to straighten all parts of the toe. The more deformed the toe, the more steps will be used from simply fusing the toe joint straight to breaking the metatarsal head and repositioning the entire toe. Tight skin has to be lengthened using plastic surgery techniques so that the toe can stay straight and the scar is more cosmetic. In general these procedures require protection from walking using a cast boot. X-rays are used to follow the toe healing process and you will be returned to shoes when your doctor sees evidence of bone healing.

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Hammertoes, Early Treatment and Prevention

Hammertoes develop when the toes buckle under the pressure of walking on an unstable foot. When your foot pronates too much, the muscles work harder to support your arch. If your foot remains unstable the toes bend as muscles fight to prevent the arch collapsing while you walk. Left untreated the toes will stay curled leading to corns, calluses, and pain.

Early treatment is important. At Desert Foot Surgeons we perform a detailed examination including video gait analysis to identify the reason for the unstable arch. If you do not correct the true cause of the problem it will only return. Foot orthotics are used to stabilize the arch and prevent hammertoes in the early stages. Once the toes stay bent treatment involves changing the shoes that push on the painful toe or surgically straightening the toe.

Dr. Stephen Geller, AZ Podiatrist