Friday, October 26, 2012

Why Pain is Good

Really?  How can this be?  To talk to most people, they will do just about anything to avoid pain.  Indeed, I spend a lot of my time treating patients who have pain that keeps them from doing the things they enjoy in life.  Just ask a person with heel pain, or a painful ingrown toenail, and they will tell you how much pain is, well, a pain!  But pain is there for a reason.  Pain lets us know that there is something wrong and needs attention.  Imagine if you were to break a bone in your arm and have no pain.  You would likely not think there was anything wrong.  You would not protect the arm or seek treatment.  And it is likely that the fracture would not heal properly.  This is why pain is good, even though no one likes it.

For my diabetic patients, pain is not only good, but vital.  Problem is, many patients with diabetes develop a condition called peripheral neuropathy.  With peripheral neuropathy, the sensory nerves (primarily in the feet and lower legs) do not function as they should.  The pain signal is not transmitted to the brain.  This leads to some severe consequences.

A patient I saw recently was a perfect example the consequences of peripheral neuropathy.  He was working and stated that at the end of his work shift, his foot felt uncomfortable.  When he took off his shoe, he found that he had stepped on a nail that had gone through his shoe and into one of the bones in his foot.  Now, if I had stepped on a nail, you can bet that I would know right away that something was very much wrong.  I suspect that everyone around me would be aware as well, as they would likely cover their ears from my screaming.  However, this patient likely walked around for at least a few hours with a nail in his foot!  This of course made a bad situation worse.

Most of the time, the problems I see are not as dramatic in their presentation, but have the potential to be equally as devastating.  Quite often, it is not the nail in the foot that causes the ulcer or sore to form, but the constant light pressure from a callus or ill-fitting shoes that causes damage to the skin.  For this reason, I strongly urge all my diabetic patients to inspect their feet daily looking for signs of an ulcer developing.  These signs can include redness, swelling, bleeding.  If calluses are present, darkening of the callus can be a sign of bleeding and skin breakdown.  A best case scenario is to have a spouse, partner or friend inspect the feet, as it can be difficult to fully examine your own feet.  And by all means, if anything is seen that raises a concern, DO NOT DELAY calling your podiatrist to have your feet looked at!  It may save you from a long, difficult healing process.  It may avoid the need to amputate your leg.
To learn more about diabetes and its effects on the feet, please visit my website at

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