If you’re age 50 or older, overweight and have recently experienced pain, tingling or numbness in one or both feet, you fit the classic profile of a person with diabetic neuropathy (DN).
This condition occurs when diabetes leads to nerve damage, which most often affects the feet. Sometimes DN hurts, while other times it creates an inability to feel pain, heat or cold. This loss of sensation is serious, because a sore or ulcer can go unnoticed, become infected and sometimes lead to a foot or leg amputation—so your doctor diagnoses you with DN.
Here’s the kicker: You may not have DN—or diabetes. Even though people who are overweight are at much greater risk for type 2 diabetes, you may not have the disease.
Still, when doctors see a heavy patient with foot pain, tingling and/or numbness, many are quick to assume that it’s DN. Add to that the widespread advertising for pregabalin (Lyrica), an antiseizure medication often used to treat the nerve pain of DN, and you can see how many doctors would jump to this treatment. Lyrica can be effective when properly prescribed, but it’s a powerful drug with side effects, including dizziness, blurred vision, weight gain, difficulty concentrating and, in rare cases, suicidal thoughts. If you take this drug but don’t actually have DN, you put yourself at risk for these side effects…while failing to address the real cause of your foot troubles.
WHAT ELSE COULD IT BE?
If your doctor has diagnosed you with DN, make sure that your blood tests (such as a fasting blood glucose test) confirm that you actually have diabetes. If you are not diabetic but your physician has diagnosed DN, it’s time to find a new doctor. But if you don’t have DN, then what’s causing your foot problems?
UNRAVELING THE CLUES
Based on my experience treating hundreds of patients with foot pain who were misdiagnosed with DN, I recommend special exercises.
To ensure that you’re doing the most effective exercises, it’s crucial to isolate where you’re experiencing pain or numbness in your foot—is it all over…on top…or on the bottom? What the location may mean…*
If your entire foot is affected—it could be sciatica. This condition, characterized by shooting pain that travels down one or both legs, can occur when the piriformis muscle in the buttocks compresses the sciatic nerve, which runs down the leg before branching off in the foot. The result can be gluteal pain, as well as pain, numbness or a “pins and needles” feeling in the foot. Sciatica often occurs when the gluteus medius muscle above the hip joint is weak, leading the piriformis muscle to compensate.**
Self-test for a weak gluteus medius muscle: Look at yourself in a mirror while standing casually. Does one hip naturally sit higher than the other? A higher hip indicates that the lower back muscle on that side is overworked and shortened, pulling the hip higher. This points to sciatica—not DN—as the cause of your foot discomfort.
To strengthen the muscles of the weaker hip, do these two exercises…
• Hip abduction. Lie on your side, with your bottom leg bent at the knee and your top leg (the weaker one) extended in a straight line. Rotate the foot of your extended leg slightly so that your toes point down and your heel is the first to rise. Raise your top leg several inches keeping it parallel with the floor, then lower it, keeping movements controlled.
Perform two to three sets of 10 repetitions, two or three times a week. If doing 10 repetitions is easy, add a weighted ankle cuff (available online). Begin with a one-pound weight and increase weight when the exercise becomes too easy. Do the exercise on your weak leg only.
• Dorsiflexion. Slip one end of an elastic resistance band around a sturdy table leg. While wearing sneakers, sit on the floor facing the table. Extend your weak leg, bend your knee and slip the other end of the resistance band over your instep. Point and flex, keeping the heel stationary and movements slow and controlled. Perform two to three sets of 10 repetitions, two or three times a week, on your weak leg only.
If just the top of the foot is affected—you may have a pinched peroneal nerve. This happens more frequently in people with strained hip muscles. Symptoms are similar to those of weak gluteal muscles. Unlike sciatica, however, there’s no gluteal pain, and the altered foot sensation is on the top of the foot only—not all over. To strengthen hip muscles, perform the two exercises above, plus this exercise…
• Inversion. Knot a resistance band on one end, and place the knotted end behind a closed door. Sit in a chair, parallel to the door. Loop the other end of the resistance band around your instep. Angle your toes slightly to the outside of the heel, then stretch the band until toes are in line with the heel. Perform two to three sets of 10 repetitions, two or three times a week, on your weak leg only, using slow and controlled motions.
If pain is in the sole of your foot—you may have a collapsed arch.
What can happen: If the gluteus medius or the muscles that support the arch are weak, your arch may flatten. When this occurs, the sole of your mid-foot will be flat on the floor when you stand or walk, compressing nerves in the bottom of the foot. This triggers tingling and/or numbness in the sole.
Self-test for a collapsed arch: Wet the sole of your foot, shake off any excess water, then step on a brown paper bag. If the arch side of your footprint is filled in, you may have a collapsed arch.
To alleviate pain, do all three of the exercises above.
*If your foot pain, regardless of location, isn’t eliminated by these exercises in four weeks, see a neurologist.
**If sciatica causes severe pain or you have trouble controlling your bowels or bladder, see a doctor right away,