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How people with peripheral neuropathy keep their feet healthy

By Samuel Kolodney 1 years ago 754 Views No comments

This video by Barry Jacobs D.O. offers insights into how people who are in danger of developing diabetic peripheral neuropathy can quickly and easily test to make sure their sense of sensation is still intact before serious complications develop that can lead to foot ulcers and amputations.

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ADA Recommends Pinprick Test for Asymptomatic Diabetic Neuropathy

By Barry L. Jacobs D.O. 2 years ago 582 Views No comments

With the release of the ADA’s new guidelines for 2017, there is much attention focused on early diagnosis of diabetic neuropathy or symmetrical neuropathy and that subtle signs of loss of pinprick or temperature sensation are important signals to implement appropriate management. But, there is still some confusion as to what might constitute Loss of Protective Sensation (LOPS).

In its annual position statements the American Diabetes Association often describes LOPS as if it were exclusively synonymous with failure to feel light touch. However, since the ADA's new 2017 guidelines acknowledge that pinprick is likely to be the first modality to be lost in diabetic neuropathic degeneration, due to the vulnerability of its small constituent fibers, then rather than light touch we primarily need to address the loss of the patients’ capacity to detect pain and other potentially harmful stimuli.

Essentially pain is a protective mechanism. That is precisely what it is for. This is the very implication of the term “The Gift of Pain” as forms the eponymous title in the well know volume (Brand P, Yancey P. Zondervan. Reprint edition September 1, 1997)
. In particular, this book was influenced much by the effect of Hansen’s disease (formerly known as leprosy) to cause neuropathy and loss of protective sensation leading to serious complications. If a patient fails to feel that they are treading on a shard of glass, which can penetrate their skin, then certainly they are vulnerable to damage. It is important to note that, unlike light touch, pain sensation is there to protect and does not permit habituation. We rapidly become used to the sensation of long hair or clothes on our skin but not to painful, noxious feelings that can be caused by encounters with objects that can harm or penetrate the skin. Light touch neither warns us against damage nor diminishes early on in the neuropathic process. Therefore, the Gift of pain is to protect us and pinprick is a remarkably valuable test for this. Loss of pain IS loss of protective sensation.

Medipin is a precision device that provides consistent pinprick sensation testing while shielding and inhibiting penetration of the point

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