Numbness, pain or burning are warning signals from our nerves that something is wrong. The goal of treatment is to find out what is wrong and to fix it, not to just mask or cover up the warning signs. View this presentation to learn more.

1. Peripheral Neuropathy
A Critical Look/Fact or Fiction

2. What exactly is “neuropathy”?
(nerve cell)

3. Neuropathy is:
the progressive loss
of nerve fiber function.

4. Diabetic peripheral neuropathy
has been defined as:
“The presence of symptoms and/or signs of
peripheral nerve dysfunction in people with
diabetes after the exclusion of other causes.”
Boulton, AJ, et. al, Diabetic Neuropathy. Med Clin North America, Jul 1998:82(4): 909-929.

5. Unfortunately, no one pays much
attention to the last and most
important part of that definition
“after the exclusion of other causes.”

6. Fact:
Peripheral neuropathies are the most common
complication of diabetes mellitus (DM).

7. It is believed that up to 50% of both
Type I and Type II diabetics are
affected.

8. If diabetes was the main etiology for peripheral
neuropathy then shouldn’t all diabetics
eventually end up with neuropathy?

9. Type I diabetics are potentially affected with this nerve
condition after decades of chronic uncontrolled blood sugar
levels
while
Type II diabetics can have signs/symptoms of
neuropathy after only a few years of diagnosis.
Strange Fact:
(Seems like it would be the other way around?)

10. Type I diabetics don’t develop
signs/symptoms of peripheral
neuropathy until they are in their
40s/50s.
Average age of diagnosis of Type I DM is 14 years old.

11. Type II diabetics aren’t diagnosed
until they are middle aged or older.
50 years old and older.
Unfortunately, that number is getting younger due to increase in type II pediatric diabetes.

12. No one can refute the fact that the
loss of sensation on the bottom of
the foot is not a good thing.

13. It leads to all sorts of problems.

14. And it’s more complicated then
just the loss of feeling.

15. There is also painful neuropathy.

16. Neuropathy severely affects the
quality of one’s life.

17. Besides living with severe pain

18. There are secondary effects including
• Foot ulcers-
– Typical cost to heal a foot ulcer- $8,000
– Typical cost to heal an infected ulcer-$17,000
• Falls
• Fractures

19. But the worst thing is:

20. Amputation

21. It is estimated that someone loses a
leg every 18 minutes as an ultimate
complication from neuropathy.
Average cost for a below-knee amputation (BKA) is $45,000
There are 80,000 BKA performed/year
Usually the opposite limb develops an ulcer within 18 months
58% go on to have a BKA of the residual limb within 3-5 years.

22. Anything and everything needs to
be done to combat this
progressive nerve disorder.

23. The unfortunate
fact is that once a
patient presents
to a doctor with
nerve symptoms
the first thought
the doctor has
is:

24. DIABETIC NEUROPATHY!

25. At that point the case is closed.

26. “Sorry, we can’t do much for you.”

27. It will only get worse.

28. Sure, you can try to keep
your blood sugar under
control.

29. You can take vitamin
supplements and wear
cushioned shoes.

30. Keep coming back for check-
ups so that we can monitor
how bad it is getting.

31. If you develop painful
neuropathy we will offer
you pills to mask the pain.
Have you ever taken a look at the possible
side-effects of those pills?
You might be surprised.

32. Don’t worry I am going
somewhere with this.

33. What is it about diabetes that leads
to the destruction of nerves in the
feet and hands?

34. The fact is- we really don’t know.

35. There is quite a bit of confusion as
to why and there are several
theories.
Only thing is that none of them have
really been proven.

36. DM peripheral neuropathy
is blamed on:
• Long-term high blood sugar levels
• High cholesterol
• High blood pressure
• Smoking
• Increased height (taller than normal?)
• High exposure to ethanol
• Genetic factors

37. Diabetes isn’t the only disease that
affects the peripheral nerves.

38. There are several other forms of
neuropathy including:
• Alcohol consumption
• Chemotherapeutic medicine
• COMPRESSION of the nerve
• Familiar (parent/grandparent)
• Idiopathic (can’t figure out why, can’t blame it on anything
else)

39. Besides the co-finding that you also
have a family history of
neuropathy, have been diagnosed as
being “pre-diabetic”, Type I or II
diabetic, had
chemotherapy, excessive amount of
alcohol consumption for to many
years, or we don’t know why you
have it…

40. … are there different findings as far
as the signs or symptoms of
neuropathy?

41. In other words, there is
not one symptom or finding
that links the cause of nerve
damage to
diabetes, genetic, alcoholism, kn
own or unknown reason.

42. What I mean is that we don’t say
“oh you have diabetic neuropathy
because you have pain or loss of
feeling in your big toe” or “if you
have pain or loss of feeling in your
little toe it is related specifically to
chemotherapy”.

43. Peripheral nerve facts
• Nerves outside of the spine are capable of
repairing themselves when damaged.
• Nerves are able to withstand up to a 6% strain
without being affected.
• Nerves can be slightly flattened without long-
term damage.

44. What about nerves that are constantly
being over-stretched while at the same
time being flattened and compressed?

45. And this happens-
day after day,
week after week,
month after month,
year after year.

46. Another fact:
Overwhelming majority of
individuals suffering with peripheral neuropathy
are over 40 years of age.

47. The majority are over 50 years of age.

48. Let’s shift our focus to dysfunction
of nerves on the bottom of the foot.

49. Walking is the second
most common
conscious function of
our body.

50. Average person takes
6,000 steps a day
42,000 steps a week
168,000 steps a month
2,016,000 steps a year
40,320,000 steps in 20 yrs
80,640,000 steps in 40 yrs
120,960,000 steps in 60 yrs

51. Remember earlier we learned that
most diabetics (either Type I or Type
II) don’t develop peripheral
neuropathy signs/symptoms until
they are 40 years old or older.
Anyone 40 years old has on average
taken over 80,000,000 steps.

52. Did you know there is
one main nerve
collecting all of the
sensations from the
bottom of the foot?
Tibialis posterior nerve

53. All of the nerves
from the bottom
of the foot travel
toward the spine
from behind the
inner ankle
bone.
Tibialis posterior nerve

54. The exact area
where the nerves
from the bottom
of the foot travel
to the ankle area
is a very
potentially
dangerous area.

55. There are 2 tissue
tunnels where the
nerves transition
from horizontal to
vertical orientation.

56. There is a reason why I am
pointing this out- keep going.

57. Hindfoot alignment is very important
for many things but especially when it
comes to these 2 tunnels.

58. When the ankle bone (talus)
dislocates (partially) on the heel
bone (calcaneus) this has a dramatic
and very bad effect to the nerves
within those two tunnels.

59. The partial dislocation of the ankle bone on the heel
bone has been scientifically shown to:
cause pathologic over-stretching of the nerve(s)
&
abnormally increases the pressures within the tunnels
The Effect of HyProCure Sinus Tarsi Stent on
Tarsal Tunnel and Porta Pedis Pressures.
Journal of Foot and Ankle Surgery, Volume 50, (1) Pages 44-49,
January 2011
Effect of Extra-Osseous TaloTarsal Stabilization on
Posterior Tibial Nerve Strain in Hyperpronating
Feet: A Cadaveric Evaluation
Journal of Foot and Ankle Surgery, Volume 50, (6), Pages 672-
675, November 2011

60. A mis-aligned hindfoot leads to
constant compression
and
overstretching of the nerves
while standing.

61. And a mis-aligned hindfoot leads to
intermittent damage
with every step taken.

62. Walking is supposed to be so good
for you. That is, unless you have
mis-aligned feet!
There are hidden dangers
of walking!

63. Many people with peripheral
neuropathy will tell you that the
symptoms aren’t so bad or even non-
existent when they first get out of bed in
the morning …

64. …but the longer they are on their
feet then the symptoms get worse.

65. WHY?
Because when they were laying down and off
their feet the nerve was not being
overstretched nor compressed.
Upon weightbearing the nerves were being
crushed and over-stretched.

66. Other individuals with painful neuropathy at
night have often gotten out of bed and
started walking round and round until finally
the pain in their feet went away.

67. The reason why the pain was worse
after they had been off their feet
was that the nerves were “waking
up” and walking around made them
go “back to sleep”.

68. There is a strong correlation
between foot neuropathy and
faulty foot mechanics.

69. The problem with only releasing any
entrapped nerves is that nothing is usually
done to realign the foot.

70. Arch supports may be beneficial, but for
many patients these devices just end up
pushing on the nerves and make their
symptoms worse.

71. A somewhat new and more
importantly, scientifically proven
internal option now exists.

72. HyProCure®
Extra-osseous, extra-
articular, talotarsal fixation device.

73. Did you know…

74. HyProCure®
has been used safely and effectively in thousands
of pediatric and adult patients since 2004.
Stabilization of Joint Forces of the Subtalar Complex via
the HyProCure Sinus Tarsi Stent
Journal of American Podiatric Medical Association, Volume 101 No. 5, Pages 390-399, Sept/Oct 2011
Extra-Osseous Talotarsal Stabilization using HyProCure in Adults: A
5 Year Retrospective Follow-up
Journal of Foot and Ankle Surgery – Vol. 51 (1), p. 23-29, 2012

75. HyProCure®
is the only extra-osseous talotarsal stabilization
device that works with the normal mechanics
unlike other devices that work against the normal
function and often leading to failure of the device.
+ =

76. HyProCure®
is the only medical treatment that has been
scientifically proven to decrease the pressures within
the tarsal tunnel and porta pedis while at the same
time decreasing the strain on the nerve.
The Effect of HyProCure Sinus Tarsi Stent on Tarsal Tunnel and
Porta Pedis Pressures.
Journal of Foot and Ankle Surgery, Volume 50, (1) Pages 44-49, January 2011
Effect of Extra-Osseous TaloTarsal Stabilization on Posterior Tibial
Nerve Strain in Hyperpronating Feet: A Cadaveric Evaluation
Journal of Foot and Ankle Surgery, Volume 50, (6), Pages 672-675, November 2011

77. Every effort must be considered to
eliminate any factor that could lead to
the destruction of peripheral nerves.

78. Generally speaking, the medical
establishment has always been
against any surgical option.

79. We have followed their advice of:
early detection
frequent physician visits
strict diabetic control
but the disease still remains and often gets worse.

80. The need for early surgical
intervention is important.
While standing, walking, or
running the nerves to the
bottom of the foot are being
destroyed.

81. Eventually, the critical threshold is
reached where there is no chance of
the nerve to heal itself.

82. While we can’t ignore the fact that high blood
sugar, excessive alcohol consumption, and the
other potential causes must be controlled or
eliminated, we cannot ignore the simple facts
of the trauma inflicted on the nerve as a
result of the faulty foot alignment.

83. The risk benefit analysis of the
HyProCure®
option shows that the
benefits are far greater then any
potential risks.

84. Let’s do all that we can to make a
difference