Sensory peripheral neuropathy is present in at least 45% – 88% of people with diabetic foot. It may be symptomless or may produce symptoms which are so mild or vague that they are ignored. Sometimes a burning pain, often worse at night , may be present in the limb and this may lead to incorrect diagnosis and inappropriate local treatment.
Autonomic peripheral neuropathy can be likewise relatively symptomless. The foot is warm , and the pulse is easily felt , and the veins are easily distended in the lying position .
The interaction of PVD and peripheral neuroparthy entities coupled with negligence produce a variety of foot conditions , such as corns, calluses, ingrown toenails, skin lesions, foot ulcers and gangrene. Most foot infections leading to amputation can be traced to neglect or mismanagement of corns and calluses. Neuropathy of the diabetic foot is manifested by burning tingling , pins and needle sensation. Hammer toes and bunions are prone to ulceration from the shoe pressure. The calluses at the bottom of the foot are subject to constant shearing stress from improper shoe inserts and will eventually ulcerate . These ulcers are very frequently infected. The infection destroys tissue and clogs up the small blood vessels of the foot leading to gangrene and amputation. Blood vessel disease of a diabetic lower extremity involves most frequently the large arteries below the knee. In this process of blood vessel disease coupled with neuropathy danger of losing the leg is very high. In addition , cigarette smoking can lead to nerve damage and reduce blood flow to the feet.