What is neuropathy and when do I need to see a specialist? You know him, you love him… Dr. Jeffrey B. Klein, DPM is back in the podcast chair to talk about those tingles that you have been feeling in your feet. Covering everything medical, from head to toe, it's the Head to Total podcast!
#neurpathy #specialist #DPM #Doctor #Tiktok #Tiktokstar #Medical #Diabetes #Diabetic #footcare #Synergy #Healthcast #Detroit
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What is neuropathy and when do I need to see a specialist? You know him, you love him… Dr. Jeffrey B. Klein, DPM is back in the podcast chair to talk about those tingles that you have been feeling in your feet. Covering everything medical, from head to toe, it's the Head to Total podcast!
#neurpathy #specialist #DPM #Doctor #Tiktok #Tiktokstar #Medical #Diabetes #Diabetic #footcare #Synergy #Healthcast #Detroit
Refresh by Roa Music | https://soundcloud.com/roa_music1031
Music promoted by https://www.free-stock-music.com
Creative Commons Attribution 3.0 Unported License
https://creativecommons.org/licenses/by/3.0/deed.en_US
Colleen Young: [00:00:00] Hi everyone. Welcome to the next episode of Head to Total, our podcast that pulls back the curtain on all things medical. You know 'em, you love him. Dr. Jeffrey B. Klein, our favorite podiatrist is here with us today. Dr. Klein, how have you been?
Dr. Jeffrey B. Klein: I've been doing great. Thank you. How about yourself?
Colleen Young: Doing good, doing good. Paying attention to all the advice that you have given me. How's business? Everything going okay?
Dr. Jeffrey B. Klein: Great. Things are very busy. This is the time that the office gets very busy. Lots of foot problems out there.
Colleen Young: Oh, congratulations. That's great. That's great. Dr. Klein, one of the reasons why I wanted to talk to you today:
One of the things that I've been getting questions about, and I myself have been experiencing, now I'm experiencing it in my hands, not my feet, but I think you can explain the behind [00:01:00] the scenes on this, right? I'll be sitting at my desk or I'll be laying down on the couch and all of a sudden my fingers, my hand, they feel like they're falling asleep.
And it's my right hand especially, and that's my dominant hand. It feels like little needles or it feels like it's falling asleep. So I talked to one of your colleagues and they said, “it's neuropathy.” And I said I don't know what that means. So they said, “people often experience neuropathy in their feet.”
So what's happening with the tingling? What is this?
Dr. Jeffrey B. Klein: So neuropathy is a very common condition that's seen in a very large population of men and women in the United States. It seems to be increasing. Neuropathy, simply said, is nerve damage or basically if you think of neuropathy as the nerves [00:02:00] that will transmit the feeling. Or, the signal to the fingers or to the toes don't function properly, and so sometimes people will get numbness, burning or tingling. That's usually how it starts, and it can be related to many different types of conditions. The most common cause of neuropathy is diabetes. Now, that doesn't mean if you have neuropathy that you're a diabetic, but it's definitely one of the most common causes. The second most common cause of peripheral neuropathy or neuropathy in the hands or the feet is basically nutritional problems or basically anemias. Anemias can cause that. And the third most common cause of neuropathy is alcoholism. Alcohol can affect [00:03:00] the - oh, there, we found your [Colleen’s] problem.
And that can cause the nerves to not function properly and to give you abnormal signals, the nerves will innervate or help the, or tell the muscles or tendons to move. So with severe motor neuropathy, you can actually get weakness in the feet or elsewhere.
Colleen Young: So I know that you've done, there was a TikTok video that I watched that featured you and you were talking about diabetic foot care.
But can you walk me through like how serious is the neuropathy - is it like, “okay, Dr. Klein, I'm starting to feel some numbness and tingling in my foot, in my toes.” Is that immediately I should be seeing Klein? Is it something that could happen…because I'm sitting on my, you know how like when you sit in a chair, sometimes you'll sit on your leg and your foot goes numb, [00:04:00] or your shoes might be a little bit too.
Is there a scale where you would say, yeah it's time to see Klein. You're getting this numbness and tingling three to four times a week. What's the gauge there, Dr. Klein?
Dr. Jeffrey B. Klein: Neuropathy if it's significant, meaning if it's lasting for a long period of time, not if you're just sitting in a bad position or sitting on your knees and you get a temporary tuck neuropathy that I'm not talking about.
I'm talking about something that just won't go away or becomes very frequent. Neuropathy is something that should be checked out. One of the things that's very important is that you should have a physical performed by your primary care physician at least once a year. If you're a diabetic, obviously more common than that. But it's important to get it checked out because there are many different causes of neuropathy. Neuropathy [00:05:00] can start off very minor, like a little bit of numbness, burning or tingling at night, or even some weakness. Can start off like that. Any kind of weakness should be evaluated almost immediately by our office.
But when it comes to numbness, burning, and tingling, that's not going away or is being pretty frequent then it should be evaluated in our office. And there's many ways we do evaluate it.
Colleen Young: When you're talking about weakness in the foot, how do you, I'm sitting at home, my husband says, you're feeling that tingling in your feet again?
Do I just have him push on my foot? What's a good at home judge of weakness in your feet?
Dr. Jeffrey B. Klein: Well I guess the best judge of it is how you're walking where prior to neuropathy or prior to muscle weakness, you're walking pretty normally, and your stride, your gait is pretty normal. You're not [00:06:00] falling, you're not feeling unstable.
If you have neuropathy or this motor neuropathy that's already affecting the motor part of the nerves, that's giving you the inability to pick your foot up, for instance, or drop foot, that is one of the ways you can diagnose it or basically tell you to go seek podiatric care for evaluation of this.
The motor neuropathy is less common than the sensory neuropathy or just the feelings of abnormalities, things like numbness, burning, tingling. Sometimes it's a sharp pain. Sometimes it's a cramping type pain, and these are the types of things that should be evaluated. But if you come into the office for that with sudden onset of neuropathy or chronic onset of neuropathy for several weeks or several months, then the first thing I'm gonna ask you was, when was [00:07:00] the last time you saw your primary care physician for a physical examination? And if it wasn't recently or somewhat recently in the past year, then I would refer you directly to them. But if you have, and you've been evaluated for things like diabetes and you're not a diabetic, then there's different things that you can do to evaluate this neuropathy.
But basically when it comes to weakness in your feet and ankles, that should be evaluated immediately. And I think walking or just balance is a good example of motor neuropathy.
Colleen Young: One of the benefits of hanging out with the team at Mendelson Corn Bloom Orthopedics, and especially with you, there have been times when I'm just walking down the hall in the clinic and one of your colleagues, Dr.
Steve Mendelson, was walking behind me one day and he goes, “your hips are off.” And [00:08:00] he goes, “your hips are off because you gotta go see Kline cuz you got something wrong with your foot.”
And, feet are when you don't know how your gait should be when you don't even realize that you know, my one foot turns.
I think a lot of people are very confused on what really is a normal walk and a normal gait and your feet rolling and they're tingling, I think there's a lot of questions there. Is there a way to determine if you're walking appropriately, you may have no pain, but that your foot is rolling and that could be an indication of something?
Dr. Jeffrey B. Klein: Absolutely. The way, what we look for is changes and what you should look for is changes. You go through your life and you walk a certain way. Some people turn their feet in a little bit. Some people turn their feet out a little bit, and this could be going on for years. But if you see an onset of change with that, where it's turning in more or you're stumbling or falling,
[00:09:00] these are critical signs that you need to be evaluated by someone on our team. But in the podiatrists office, in our office, we'll actually watch you walk and look for different things. There are lots of abnormalities that can cause weakness, and there's lots of deformities that can cause feet rolling in or rolling out high arched feet and flat feet. So change is what you're looking for along with symptomatology. If the symptoms are increasing you better get evaluated. If somebody says to you, how come you're walking like that, or what's hurting, or what's wrong? That's a time to get evaluated.
Colleen Young: If you're having neuropathy and you notice that your shoes are wearing different. Like sometimes I've been told that the soles of your shoe or the side of your shoe is wearing when it never did [00:10:00] before.
Is that another indication, Dr. Klein of, “Hey, I didn't realize I was walking funny, but I'm having this tingling and now my shoes are wearing on the right outside portion.” Are those are definite signs to come see you immediately, correct?
Dr. Jeffrey B. Klein: Yes, those are definite signs to see me. However, don't confuse the neuropathy with other types of foot deformities that will cause you to walk differently.
It is definitely up there, especially when you have tingling in your feet, and you've never had that before. But there are other things, biomechanical problems that can cause you to walk differently or can cause abnormal wear on your shoes. And so one of the things I like to do is look at people's shoes and see how the wear is.
But neuropathy is the motor or the sensory, the numbness, burning and tingling or weakness. And those are different [00:11:00] types of problems usually manifesting itself in this symptomatology that I just talked about, the nerve type pain versus the weakness.
Colleen Young: Let's go back to something you said earlier, and again, I know there's a TikTok video of you explaining the importance of when you have a neuropathy and you are a diabetic.
But can you walk us through why those two are so closely connected and what diabetics should really be on the lookout if they're feeling the tingling, numbness and burning.
Dr. Jeffrey B. Klein: Okay diabetics, like we said, diabetic neuropathy is the most common cause of neuropathy. Blood sugar levels are elevated and they cause nerves to be damaged.
So as a diabetic, if you have no numbness, burning, or tingling and no foot problems, you should be evaluated by a podiatrist at least once a year. And we check for signs of neuropathy. But the [00:12:00] reason that diabetics end up with a lot of the foot problems that they have. A lot of sores, ulcerations infections are because of the neuropathy.
What happens is neuropathy can give you those symptoms and it can also cause numbness. In severe neuropathy, you can have complete numbness of your feet where you could actually take a needle and poke it through your foot and not feel anything. And it just gives you the sense of that's how bad neuropathy can get.
So the reasons diabetics run into problems is if they do not protect their feet. They wear a pair of shoes that are too tight and start to rub, and somebody who doesn't have neuropathy, has good feeling in their feet, they're gonna stop. They're going to change their shoes or get rid of those shoes and get a new pair.
If you have [00:13:00] neuropathy, you may not feel that the shoe is a size and a half too small. Or other diabetics walk around barefoot and we all, even in the cleanest of houses, we all drop things on the floor and they walk along and you can step on something and get a needle, an insulin needle, or a foreign body lodged in your foot, and you may not even feel it as a diabetic who has neuropathy.
So the way people, the reason people will come into the office is they'll notice puss or they'll notice blood on their socks and they don't understand why. And they'll come in and we'll take an x-ray sometimes if we suspect a foreign body or an infection and we'll find a foreign body. We'll find something like an insulin needle in the foot that the patient never even knew that in infection can be very serious in somebody who has [00:14:00] diabetes,
Colleen Young: Does neuropathy… cuz I know, whenever we're together, Dr. Klein, we talk a lot about the foot, but you also do work with ankles.
Dr. Jeffrey B. Klein: Absolutely.
Colleen Young: Does any of that neuropathy move up the foot and into an ankle or something like that and what ankle issues are caused, you were saying about foot drop and things like that.
How does the neuropathy in the foot affect the ankle? And does the ankle get affected by the neuropathy? Just, does it spread up the foot? What happens there?
Dr. Jeffrey B. Klein: Yes. So peripheral neuropathy can affect the foot, the ankle, the leg, and even more proximal to that area. So like we talked about, there are different causes for neuropathy.
There are things like compression neuropathies, or pinched nerves. In the back, for instance, that can cause weakness in the foot, and that could be [00:15:00] the first symptom or the first sign of a back problem, even without having back problems. So what happens is peripheral neuropathy can cause that numbness or those strange feelings, or even some increased sensitivity for a certain period of time.
And that can cause you to walk differently. And so what happens is your ankle can turn inward, can turn outward, because the tendons are not functioning the way they used to function or in a more normal position or normal gait. And therefore you start to have breakdown of joints. The most severe complication of diabetic neuropathy, or one of the most severe is charcot arthropathy, which gives which is caused by the inability to feel where your feet are when you're walking. [00:16:00] What that means is that we can walk on uneven surfaces because our ligaments in our feet, in our ankles, or in an our entire body will send signals to our brain. Let's say we're walking and we're tilting to the right side because the ground we're on a small incline or the ground's uneven. So without stopping and thinking about it, our brain says, fire the muscles to strengthen them, to tilt you more to the left side so you don't fall down and with neuropathy, with the law, and that's called proprioception.
When you don't know where you are in space. So with neuropathy, you lose that proprioception, or you can lose proprioception and you start to get breakdowns of joints in your feet and your ankles. Where I've had patients who have severe [00:17:00] neuropathy that have come into the office because they have lots of swelling, no pain at all, just numbness, lots of swelling, and we can take x-rays of their feet and we can find multiple fractures in their feet or the ankles that they've been walking on and did not even know it.
I think the record I have in my many years of practice is something like 23 fractures found in somebody's foot that didn't even know they had it. And that's a severe condition known as charcot arthropathy. It's also seen in non-diabetic patients, but it's usually seen in patients who have severe neuropathy or numbness.
Colleen Young: So when you had that patient that had 23 fractures, foot and ankle, is that an immediate operation or.
Dr. Jeffrey B. Klein: Absolutely not. There's different stages to this charcot arthropathy. So the first thing you've gotta [00:18:00] do is you've gotta calm this foot down. All this inflammation, all this redness that in this case was not infection.
It was more inflammation. What I will usually do for a patient that comes in with an acute flare up of this charcot arthropathy, which means it just happened in the last couple of weeks and it's quite swollen, maybe warm, and there may be clinical evidence of deformity. I will get them off of it. I will immobilize them sometime, I'll put 'em in a cast, or sometimes I'll put 'em in a boot and get them off of it with a knee walker.
Or something alike until you can calm it down and get the bone fractures to start to heal or to consolidate. At that point, maybe some three months later, depending on what type of deformity is seen in the foot or the ankle, then, [00:19:00] possibly surgery would be an option, but there are also many other options such as immobilization or bracing and different types of shoes or orthotics in a shoe.
So no, surgery is not necessarily the first line of treatment for this severe condition, but it may be down the road depending on how things consolidate or heal.
Colleen Young: You were mentioning that there are some neuropathies that could indicate you've got a back problem about to happen. Can you walk us through, no pun intended, could you walk us through, can you walk us through what that means?
Cuz I think a lot of people, again, we don't realize how everything is so connected and when you're starting to feel x, it could be y.
Dr. Jeffrey B. Klein: Absolutely. As the old song goes, the knee bones connected to the ankle bone, everything is related, especially in gait, but when you have weakness in your feet and it's caused [00:20:00] by some type of compression in the spine or some nerve problem coming usually in your low back, at least as the foot goes is that can be a pretty severe problem. Remember, it's the nerves that tell your muscles and tendons when to fire and how to work. And when they're not doing that is not a small problem with your back, that's a big problem with your back. And you need to be referred to a spine specialist as soon as possible to evaluate that and to see what the condition is that's causing it.
So think of it like this, think of a nerve as a garden hose and the signal or the water going through the garden hose is telling the tendons and muscles in the feet to fire. So if you're stepping on that garden hose, the water still [00:21:00] may come out or the nerve signal still may go through, but it may be abnormal and it may cause weakness or it may cause that drop foot. And that's when you need to see a spine specialist rather quickly.
Colleen Young: Dr. Klein, one of the things that I'm curious about, we've talked about neuropathy, and how it could throw your balance off. How, you know it's your walk and your gait and you're feeling that tingling.
When can neuropathy be at its worst? And does it happen when you're just moving your foot and you feel it, or. Does it happen at night?
Dr. Jeffrey B. Klein: It can happen anytime during the day. What I seem to find is patients that are newly diagnosed with neuropathy, they seem to have worse symptoms at night where they're waking up in the middle of the night because of that numbness, burning, and tingling in their feet, and they're turning and twisting and trying to get into a comfortable position, and they’re [00:22:00] not necessarily able to do that, and that's an early sign of neuropathy. Also, a lot of people will just complain of worse pain at night.
Colleen Young: Dr. Klein, you've described neuropathy is like you're stepping on a garden hose, which is a great visual, right? Everybody has done that when they were kids, right?
I still do it and I'm too old to even say my age. But when you're washing the car and you're messing around and you step on the hose to clamp. And if you're doing that and you're clamping off those nerves, I could imagine that it would spread from the foot to the ankle, to the leg.
What is your take on it going to the leg, and how do you solve that issue for a patient when that tingling is happening in the leg?
Dr. Jeffrey B. Klein: Okay first of all, any nerve throughout the entire body that goes by a movable joint, your elbow, your knee, your ankle, your foot goes through a fibrous tunnel, and basically this [00:23:00] fibrous tunnel sometimes can pinch the nerve.
Now, there's lots of reasons that this tunnel can pinch the nerve, or step on the hose, if you will. Number one is they think with diabetics that the nerves will actually swell. And so if the nerve is a certain size and it's going through this tunnel, then it can get pinched. And it can cause symptoms and it can cause weakness.
So that can be anywhere in the legs. There's multiple nerves that go through these fibrous tunnels. But let's take one of the main nerves called the common fibular nerve, which is on the side of the upper leg. This nerve can also be damaged with trauma. And the trauma can cause pinching of the nerve. And a lot of people will come into our office with the symptom of pinching of this common fibular nerve, which will cause drop foot or the inability to pick up their foot.
So they're stumbling or they're [00:24:00] tripping over their big toe. And, after this is diagnosed, there's many different treatments that are done for this, such as specialized physical therapy like nerve flossing or nerve blocks. Or anti-inflammatories. When that does not improve the symptomatology, the pain, numbness, burning, or tingling or weakness, then surgery is something that may be performed where it's a very meticulous type of surgery where a nerve is decompressed from the fascia or from tendons around it, as well as that fibrous band and sometimes will actually use a nerve stimulator that will help to stimulate the nerve. To bring it [00:25:00] back to normal or to take away the symptoms. But by way of example I've had a patient who was a very young patient who was in a car accident, had multiple orthopedic injuries, but injured her right common fibular nerve, which is on the upper right leg or upper legs. In her case, it was the right leg and conservative treatment did not seem to help the drop foot. She was tripping. And eventually I went in there and I was able to decompress the nerve in that area or to take the scar tissue or to take the soft tissues away from the nerve to give nerve room to breathe or to open the hose, and even in the recovery room, this is less than an hour after the surgery, she had improvement by somewhere around [00:26:00] 75% of her muscle strength and just bringing it upward with a outpatient type surgery that is very intense but very rewarding to do as this could be something horrible that, somebody, anybody who has drop foot tripping and causing other injuries.
Colleen Young: Dr. Klein, when I was telling you about the tingling in my hand and things like that, they were saying it could be carpal tunnel. But in your foot, it's your tarsals, right? It's your toes. So is there such a thing called tarsal tunnel syndrome. And what do you do with that?
Dr. Jeffrey B. Klein: Absolutely there is. Tarsal Tunnel Syndrome is a compression of the nerves about the ankle and the foot on the inside of the ankle or the leg. Starting in the leg going down to the ankle is one larger nerve, and it goes through a tunnel [00:27:00] called the tarsal tunnel. The floor of the tunnel is the bone of the ankle, the ceiling of the tunnel is a fibrous band and the nerve that starts off as one and then branches into multiple nerves can become compressed and usually does not cause weakness in the ankle, but causes quite a bit of pain. It can cause heel pain, it can cause paraesthesia, or strange feelings down into the foot. Usually it's the bottom of the foot to the end of the toes and maybe the top of the toes.
And these nerves can be treated in multiple different ways to get rid of this problem. With injection therapy, sometimes numbing, the nerves will put 'em to sleep, so when they wake up, they're not as swollen or as angry or as painful. There is physical therapy. There are [00:28:00] orthotics or inserts that go into your shoes that can hold your foot in a better position so the ankle bone or the tarsal bones do not compress on this nerve, and there is always surgery where we go ahead and if conservative treatment fails will actually decompress the nerves that run down the lower leg. Into the ankle, into the foot, and they branch from one nerve to two nerves and then one more nerve coming down to the heel.
So this is a very common condition and it's known as Tarsal Tunnel Syndrome.
Colleen Young: Here. Here's a stupid question, and maybe we don't use this or maybe we do, but what's a nerve actually look like? Cuz I have this image in my head of a little, wiry spaghetti looking thing? Is that what it really looks like?
Dr. Jeffrey B. Klein: So there are smaller nerves that look [00:29:00] very wiry and I wouldn't say spaghetti like, but maybe the same size or even smaller in the toes or in the hands. But there are larger nerves as you go more proximal or closer to the spine that can become pretty large. They're not hollow like a hose.
They're solid and they're composed of different types of neurons and nerve fibers around it. And so usually they're pretty yellow looking. And sometimes they can look inflamed. You can have an inflamed nerve called a neuroma or Morton's neuroma, which can cause pain in the ball of the footer in the toes.
And when you look at that, it should look like a kite string. And you see a lot of swelling of the nerve. And that's one way that the nerve looks,
Colleen Young: What's a nerve look like versus an artery or a vein? Like, obviously the nerves are contained in [00:30:00] something, right?
Dr. Jeffrey B. Klein: The nerves are contained in something, but for the naked eye, you can't see what they're contained in.
In other words, they have a yellow appearance and they can go from very small to very large. A artery is a tube that will have blood obviously running from your heart down to your toes or to your fingers, and that will look one way. And then a vein is also a tube that looks weaker or thinner, that is got a blue tint to it because there's not as much oxygen in the blood that's going from your toes back to your heart. And they're very easy to tell the difference usually when you look at them surgically.
Colleen Young: Dr. Klein, I've taken up well over a half hour. I can't say it strong enough. I gotta go back and rewatch your [00:31:00] TikTok on the diabetic foot care.
It's fascinating to me that, as we in Michigan are now approaching spring and summer that people are, gonna start walking around barefoot and they may not know that there is a needle in their foot. And it's a very it's hard to wrap your head around that, right? But diabetics do have that issue.
So I, I would tell everybody to take a watch of that TikTok of yours. Always entertaining to see you on the TikTok too, because it's like, how does he cram that much information into a one minute video, right? And hope to see more of those TikToks from you because they really have helped a lot of people.
So I, I hope you get the opportunity to make some more. Dr. Klein, thank you for telling us about neuropathy and how serious of a problem it is. It's not just, oh, I sat on my foot wrong and my foot fell asleep. And that they should come see you when they're starting to experience that. Great to see you again, Dr. Klein. Hope to see you again soon.
Dr. Jeffrey B. Klein: Nice to see you. Have a wonderful spring.
Colleen Young: Thank you.[00:32:00]