Scott Webb (Host): Neuropathy affects tens of millions of Americans, and the most common cause of the burning, tingling, and sensitivity symptoms of neuropathy is diabetes. I'm joined today by Dr. Nathan Windsor, he's a podiatrist with Franciscan Health, and he's here today to discuss the symptoms and treatment options of neuropathy.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, thanks so much for joining me today. We're going to talk about neuropathy and feet. And as I mentioned, we're just going to be two guys talking about feet today. And we've been on a little bit of a run here lately. We talked about bunions. We talked about plantar fasciitis. Today, we're going to talk about neuropathy. But before we get there, tell us a little bit about your specialty of Podiatry.

Dr. Nathan Windsor: Podiatry, it's interesting, not a lot of people are very fond of it when I meet them out in public. But everybody's got feet, and it seems everybody has a lot of problems with their feet. And we treat pretty much everything that goes on with the feet, whether it's wounds, we treat injuries, whether there's sports injuries, such as ankle fractures, metatarsal fractures, ankle sprains. And then, we do see a lot of diabetics. And that brings us to our topic today, which is neuropathy. And diabetes is the main cause of neuropathy that we see.

Host: Yeah, I hear what you're saying. And despite the fact how maybe some people react when you want to talk about feet, I'm a captive audience. I'm here for the long haul today. Just wondering if you have any clinical interests.

Dr. Nathan Windsor: As far as clinical interests, I like to treat injuries as far as like sports injuries, whether it's Achilles injuries, ankle fractures. I like to take things that are broken and help fix them and then like to see how people recover, because they're usually very grateful when it comes to they go from something's broken and now it's fixed. So, I do like that. I do also dabble into diabetic wounds and all the other basic podiatry things that people would consider like ingrown toenails. I would say my main clinical interest would be more into Sports Medicine type injuries.

Scott Webb: Sure, Sports Medicine. And as you mentioned there, we teased that we're going to be talking about neuropathy. And I know, as you were saying, that most of us have feet and we have issues and maybe we don't understand what's causing our pain or discomfort or whatever it might be. So, let's talk about neuropathy, maybe some of the misconceptions. But essentially, describe in detail if you can, what it is.

Dr. Nathan Windsor: All right. Neuropathy, it can be anything from numbness, tingling, burning, sometimes even people just feel their feet are just constantly cold. But you have peripheral nerves, which kind of send information from the spine and the brain down to the periphery. I mean, in this case, it would be the feet. So, this carries the signal down there and lets things know, as far as, you have autonomic nerves, you have motor nerves, and then you have sensory nerves. As far as autonomic nerves, in terms of what we worry about in the feet, that would be more like controlling your blood vessels, also controlling kind of sweat glands. As far as sensory, that's going to be what you feel. That's going to be more of the one we'd probably more focus on here. And then, your motor nerves is how you function. And when you have neuropathy, you have a disruption or you have inappropriate signaling, or sometimes you just have a loss of signal going to one of those types of nerves or all of those types of nerves. That's kind of a basic overview.

Host: So then wondering, because you mentioned diabetes before, is that the primary cause of neuropathy or is it diabetes and some other things as well?

Dr. Nathan Windsor: There's quite a bit of things that can actually cause neuropathy. I would say diabetes obviously is the most common cause of peripheral neuropathy. I mean, there's anywhere from 20 to 30 million people, kind of what the studies show in the United States alone, that are suffering from peripheral neuropathy. And there's probably more than that that just haven't been diagnosed.

As far as other things that we'll see that cause peripheral neuropathy, chemotherapy and cancers, definitely we see that quite a bit. Alcoholism, liver disease, kidney disease, sometimes just injury to the nerve itself can cause a neuropathy. And then, sometimes there's something called idiopathic neuropathy where we don't actually know why it started, but you have all the symptoms of neuropathy.

Host: Sure. You know it when you see it, when you diagnose it, you get patient history and so on. You know, there's a lot of shoe companies out there, doctor, and they're always trying to sell us cures or solutions. Maybe you can give us a sense of what not to do, what not to wear. In other words, like how can we help ourselves and when it comes to shoes, what should we avoid?

Dr. Nathan Windsor: As far as shoes, that's a difficult question. I'm more of the mindset that if it feels good, you should be able to wear it. As far as shoe companies talking about cures for neuropathy, there's nothing really out there that's a true study on a shoe that really helps with it. If you do have neuropathy and have the loss of sensation and your feet are numb, one thing you do need to worry about is the shoes that have the memory foam. Memory foam, it feels great when you initially put it on. But a lot of times, that memory foam takes a while to recover to its normal foam, and it doesn't provide that same offloading that you initially get when you first buy some.

Host: Yeah, you're so right. It feels great at first and it never seems as good the next time or subsequent times that we wear them. Let's talk a little bit about the symptoms of neuropathy. You were talking about people whose feet are always cold. So, is it a range of symptoms? Does it run from having cold feet to pain to just discomfort? Take us through the symptoms.

Dr. Nathan Windsor: Symptoms can be a little bit all over the place. You can have cramps, you can have sweating, you can have light touch causing severe pain such as I have a lot of times people tell me that their sheets just touching their toes at night is just horrible and it just causes this severe pain, burning, tingling, pins and needles. I'll hear a lot from people that say it either their feels like they're walking on Jell-O or they have just wraps and wraps constantly just wrapped around their feet or vise grips around their feet. So, the symptoms can range from very minor to severe.

Host: Yeah, and it sounds like the symptoms might cross over with other things, they might mirror other things. And it's probably a good reason why we don't diagnose ourselves. Wondering when it's time for us to seek medical diagnosis, medical treatment?

Dr. Nathan Windsor: That's a good question. Obviously if the symptoms are uncontrollable with over-the-counter medications, I mean, I'll have a lot of people that try like Biofreeze or over-the-counter pain medications. And if that's not helping, that's usually when we'll see them. I have a lot of people that'll use anything from alcohol swabs or alcohol soaks to peroxide soaks. And it's really if you're not able to control it yourself, or even if you're just starting to get it, ideally, if you do start to feel like the burning, tingling, if we can get you in sooner and get ahead of it, we can get it a little better under control before it gets to be a full-blown numbness or just sharp pain constantly.

Host: Yeah, it does sound like early diagnosis and treatment would help. And it does also sound like there's a lot of home remedies, things maybe their grandmas may have told people to do for their feet. So, wondering you as a medical professional, as a podiatrist then, what do you do to help relieve symptoms of neuropathy and heel pain?

Dr. Nathan Windsor: As far as for neuropathy, I mean, we do have medical treatments. We do have some over-the-counter. There's some good supplements out there that people do really well with. They're not as studied as far as true studies on them, but I do have a lot of anecdotal evidence of patients doing well with some of the over-the-counter supplements and creams that you can use.

There are some medications that we use. I mean, anytime you take a medication though, it can have side effects. The most common ones that we'll see will be gabapentin or Lyrica are two common medications used for neuropathy. But then, there are also some kind of newer treatments that are out there that aren't medical, but they're topical creams that we can use or even some topical patches that are getting more use.

So, we kind of have a range of treatments. And then, I've even also been using the help of some of our pain management colleagues. And there are some new routes as far as going pain management route, in terms of sometimes they'll do injections in the back or even some nerve stimulators that have been helping people as well.

Host: Yeah. So, there is some relief out there. And as you said, early diagnosis helps before it gets too far before you get to the numbness stage of things. It makes me wonder about risk factors, is family history, genetics, any part in this? Or is it really like diabetes, cancer, some of the things that you mentioned?

Dr. Nathan Windsor: Some of the things that I mentioned before, yeah, definitely. But diabetes is definitely a genetic thing. It definitely travels through families. Diabetes is definitely the number one reason we see neuropathy. But if you get diagnosed, if you can get that under control, that's going to be your biggest route of preventing it.

Host: Yeah. Yeah. So obviously, prevention would be great. And maybe we can prevent it, maybe not. Maybe we ignore symptoms for too long and then we finally come see you. It does sound though that once we've been diagnosed or once we really have neuropathy, that it's really more about managing the symptoms, managing the pain. Is there any real cure for neuropathy?

Dr. Nathan Windsor: I wouldn't really go out there and say there's a cure, but there's a way to manage it, the symptoms. And that's really all we can ask at this point.

Host: Yeah. So, maybe you can talk about that a little further. So, we've talked about some of the things that folks try themselves, some of the ways that you help when we think about just the process of all of this and trying management. What are your best recommendations?

Dr. Nathan Windsor: I kind of went into some of them. We do have medications such as gabapentin. That's only something you can get as a prescription. There are some other medications out there as far as prescription medications. There's something out there that's a little newer. It's called Qutenza. It's a patch of capsaicin cream that they've put into a patch, and then they leave the patch on for 30 minutes in the office here. And then, we do that once every three months. And what that can do is actually help decrease the symptoms of neuropathy. That has a lot of newer research in involved in that. Capsaicin is a cream that you can get over-the-counter. It's a little bit lower. Concentration that you can get over-the-counter. That does help. It makes your hands a little tingly or burning itself, so you just got to be careful if you're using that.

Host: Yeah. You mentioned earlier some of the side effects and that's just to make sure we wash our hands after we apply it, right?

Dr. Nathan Windsor: Right. As far as some of the supplements, there's a couple out there, Nervive and Metanx. Those are generally vitamin Bs and then some other things that are good for nerve health, just to try and get the nerve as healthy as it can be to try and get it back on track. Because these nerves can recover a little bit, but if we're constantly overloading them, especially in diabetes, with glucose, eventually these nerves just are too damaged, they're just not going to recover.

Host: Okay. Yeah, I was just thinking about folks living with this and managing neuropathy. What's the prognosis then, right? So, we said there's no real cure and it is about managing. So, their daily lives and the things that they like to do, walking, running, golfing, pickleball, whatever it might be, through management of the symptoms, are they generally able to live their lives, even with the pain that's associated with neuropathy?

Dr. Nathan Windsor: Yeah, generally most people can. Some people do fight through a little bit more pain than others. But ideally, our goal is to manage the symptoms enough that it's not debilitating and people can go out and exercise. Because if they can get out and exercise, especially if they're diabetic, it's going to help their overall health, it's going to help their mental health. Ideally, our goal is to get the symptoms under control so that these people can still live a nice, healthy, full life.

Host: Yeah. As you say, some folks just may have a higher tolerance for pain and they push through because these activities are important to them. As I mentioned before we got rolling here, I've been learning a lot about feet lately, which I appreciate, because I don't think we talk about it enough and we've been talking about it a lot lately on these Franciscan Health podcasts. So, I just want to give you a chance here at the end. Final thoughts, takeaways about neuropathy and how you can help folks.

Dr. Nathan Windsor: As far as neuropathy, we really focus on diabetic neuropathy just because we see that in an overabundance compared to any other types. But the main thing I can't stress enough is, if you do start having symptoms, let us know, come get checked out, and we can even look into maybe we need to do a blood test, and maybe you are an undiagnosed diabetic, and we can get that under control sooner. The sooner, the better, the less damage it can do to the nerves, and the better your life, and the better your symptoms will be.

Host: Yeah, that's awesome. It didn't occur to me though that, indirectly, folks may come in with symptoms of neuropathy and might find out that, "Oh, and by the way, we know what the cause of your neuropathy is. It is diabetes and we have people who can help with that as well," right?

Dr. Nathan Windsor: Yeah. Unfortunately, we do see that quite often. If uou are having any of these symptoms, let us know. And ideally, we can get the ball rolling.

Host: Yeah. As we're saying here, kind of underscoring every good reason to reach out to their providers, if you have the symptoms, get referrals if that's necessary. But definitely, don't let these symptoms go untreated, because it could be a sign that you actually are diabetic and don't know it. So, really educational today, doctor. Thank you so much. You stay well.

Dr. Nathan Windsor: Thank you.

Host: And for more information, go to franciscanhealth.org and search neuropathy. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.