According to the Indian Council of Medical Research India Diabetes (ICMR-INDIAB) study, it is estimated that around 101 million people in India are found to be affected by diabetes. Diabetic Foot Disease is when, due to uncontrolled diabetes, people develop severe pain in the legs (called as peripheral neuropathy) which can lead to foot ulceration, infection, deformity, and/or lower limb amputation. Diabetic neuropathy is seen in up to 50% of those with long-standing disease and presents with severe burning pain in both the legs, especially during sleeping hours. Diabetic peripheral neuropathy (DPN) is a common microvascular complication characterized by the presence of peripheral nerve dysfunction after excluding the other causes. Clinically, it is indeed a catastrophic disease of the peripheral nerves with symptoms of pain, paresthesia, or any other problem due to neurological deficit. Currently, the prevalence of DPN was found to be between 9.6 and 78% among the different populations across India. The prevalence of diabetic foot ulceration in India was estimated at 6.2% and the incidence of lower-extremity amputation was 0.8% of the patients with type 2 diabetes.
Diabetic neuropathy pain is a symptom of nerve damage that can occur in people with diabetes. It can feel like a burning, tingling, or sharp pain, and can be worse at night. It is caused by uncontrolled diabetes. High blood sugar can damage the blood supply to the legs, including the nerves of the legs and this causes severe pain (also called the CRY OF THE DYING NERVES). If untreated, the nerve damage causes loss of sensation in the legs. This loss of sensation can lead to not caring small injuries (as no pain sensation) and end up in uncontrolled infection (drugs will not reach this part as no blood supply) and finally in amputation.
Many studies have shown that up to 25% of patients with severe diabetic neuropathy and 31% of them with foot ulcers end up having amputation. For people with healed diabetic foot ulcers, the 5-year cumulative rate of ulcer recurrence is 66% and of amputation is 12%.
The best treatment of diabetic neuropathy pain and ulceration is by prevention and proper foot care. Meticulous control of blood sugar is very important. There are several medications that can help treat pain, including duloxetine, amitriptyline, gabapentin/pregabalin and topical ointments like capsaicin cream. Lifestyle changes with diet and exercise can help. Regular foot care, including toe nails is a must. Wear shoes that fit well and are comfortable. A combination of duloxetine and pregabalin is effective for pain relief but about 20% of patients develop significant side effects and so stop the medication. Moreover, these drugs do not address the primary problem which is loss of blood supply.
In such severe cases, Spinal Cord Stimulation (SCS) is a good option. This involves stimulating the spinal cord to relieve pain and improve the blood supply. This is a simple surgery and the patient goes home within 24 hours. SCS is usually reserved for treatment of pain in patients with neuropathic pain who have not responded to conventional treatment. Up to 70% of these patients have reported pain relief one year after initiating treatment with SCS. Many studies have shown good outcomes with SCS. This surgery is approved by USFDA.
