Plantar Neuropathy

What is Plantar Neuropathy?

There is a very concerning condition of the foot to be discussed here – nerve damage.

This is one of the conditions of the lower extremity where there seems to be no real answers or solutions because physicians have been focusing their attention on the wrong area. There are many reasons why the nerves of the foot can become diseased. In fact, there is a very long list of potential causes of nerve disease, neuropathy, and at the top of the list is idiopathic. That is “the most common” cause according to the science, greater than any other condition including diabetes because none of the physicians took a faulty foot alignment into consideration.

What is Plantar Neuropathy?

Plantar means the bottom of your foot and neuropathy is a generic term that the nerves are diseased or in other words, something is wrong. When treating a disease, we need to be as specific as possible. The more focused a physician can pinpoint what is wrong, the better a real treatment option can be given. If the physician is not sure what the specific cause of the problem is, then the treatments will be all over the place. What ends up happening is that the treatments will be aimed at symptom-relief, rather than fixing the underlying cause of what’s broken. This is exactly and very unfortunately, what is happening with plantar neuropathy.

Foot with Plantar Neuropathy

Nerve disease to the bottom of the foot is going to cause a wide variety of symptoms; for that reason, this should really be called plantar neuropathy syndrome.

The same underlying cause of nerve disease can lead to many different presenting complaints. Some people will experience pins and needles feelings in their toes; others feel like their toes are very cold. There could be severe pain that is also combined with a numbing feeling. Later in the disease process, people walk like they have had one too many “adult” beverages. The real issue is that if the underlying cause of nerve disease is not addressed and fixed early enough, then permanent nerve damage can occur. That means the nerves are no longer able to send warning signals to the spine that something is wrong and combined with a loss of feeling to the bottom of the foot, can lead to the erosion of skin and the formation of an ulcer.

What Causes Plantar Neuropathy?

This is the most important question. What we always say is “if you don’t know what’s broken, how can you fix it?”

This is where there is a big debate. The most “popular” or “blamed” causes of nerve damage to the bottom of your feet are elevated blood sugar levels. It used to be that after years and years of high blood sugar, the nerves become damaged. Now, authors are claiming that the nerve disease from diabetes occurs decades before someone is diagnosed with elevated blood sugar. That doesn’t make any sense.

There are many different causes and it could be a combination of reasons why the nerve disease has occurred but let’s make sure to uncover the obvious reasons before we start drifting into unproven theories.

One of the most common, yet overlooked, causes of nerve disease to the bottom of the foot is the same cause of the most common nerve disease to the hand – kind of. Micro-nerve trauma. If you develop numbness and tingling of your hands/fingers, it is most likely you have been doing a lot of typing with your wrists bent. This is called carpal tunnel syndrome. There is mechanical nerve trauma at a specific point along the course of the nerve where the nerve is repetitively damaged over a long period. The solution is to prevent that micro-trauma.

The issue, however, becomes unnecessarily complicated if the person happens to be a diabetic.

If their physician calls it diabetic neuropathy, then the nerve damage is treated by controlling the blood sugar levels. But if the person keeps typing with their wrists bent and the nerve is being strangled all day, then how can blood sugar level control have any positive effect? It’s just that the person happens to be a diabetic and also has carpal tunnel syndrome.

A similar and extremely common orthopedic deformity happens in the foot that leads to a similar situation in the foot. The bones of the wrist are called the “carpal” bones and the bones of the hindfoot are called the tarsal bones. There is a condition called tarsal tunnel syndrome of the foot. This is much like carpal tunnel syndrome. There is a tunnel behind the inner ankle bone that contains the blood vessels and nerves that supply the bottom of the foot. This area is prone to compression of the tunnel and that excessive pressure will have a negative effect on nerve function. It’s like falling asleep on your arm and it goes numb.

If someone with nerve symptoms to the bottom of their foot goes to a non-foot specialist, it is very unlikely that the physician will perform a thorough examination of the foot – this is why there are foot specialists. The general physician will look for health-related causes of the nerve pain versus a foot specialist who will look for mechanical issues that could lead to the nerve disease. The biggest factor that leads to nerve disease to the bottom of the foot happens when the nerve within the tunnel is repeatedly micro-traumatized.

It is very important to know what could cause the tarsal tunnel to tighten around the nerve leading to nerve pathology.

This damage happens to people who are and are not diabetic, yet they develop the same kind of neuropathy syndrome of symptoms. This condition happens to people who have a normal-appearing arch and who also have a lower than normal arch. The one factor that is present to the majority of people with plantar neuropathy is an ankle bone that is partially dislocating on the heel bone.

Ankle bone instability, a partially dislocating ankle bone, creates the perfect storm to cause the nerve within the tarsal tunnel to become damaged. The ankle bone turns inward forcing the heel to turn outward. This motion alone will decrease or flatten the tunnel containing the nerve. This repetitive compression/flattening happens with every step taken. When the ankle bone has no weight of the body acting on it, when standing, walking, or running, it is aligned on the heel bone and the tunnel is nice and open. There are normal forces acting on the tunnel and there is functioning. When weight is placed on the ankle bone, it is forced off its normal alignment on the heel bone and this flattens the tunnel and the nerve within it. This tunnel compression happens thousands of times per day with every step taken and constantly compressed while standing.

Another rarely considered factor associated with ankle bone instability occurs when the ankle bone pushes the bones of the inner foot forward.

This creates the “too many toes” sign seen when looking at the back of the heel to the forefoot. The reason why this is important is to consider what impact that has on the nerve traveling behind the inner ankle bone. The forefoot is turned outward, more than it should, and that places a stretch on the nerve. There is an unnatural over-lengthening of the nerve. The same phenomenon happens to the strong tendon that supports the arch of the foot; it gets over-stretched.

One of the other important factors that is associated with plantar neuropathy is that the older you are, the more likely you are going to develop plantar neuropathy regardless of any other health-related issue including diabetes (article).

This seems like the nerves just wear out after a while but this is not true of every older person. This syndrome is not an eventual guaranteed reward for growing old. This is still that other factor that has to be taken into consideration. What is the most common conscious function of our bodies? Walking. Breathing can be conscious but it is also subconscious.

The time has come to connect the dots of plantar neuropathy. This nerve disease begins as soon as one starts walking on a partially dislocating ankle bone. The nerve within the tarsal tunnel is flattened and elongated thousands of times per day. Nerves are very resilient structures and can handle a certain amount of trauma. Eventually, if that trauma is repeated over and over, year after year, decade after decade, that nerve will no longer be able to withstand the trauma and it will become diseased.

The symptoms of nerve disease show up as a cold toe, temporarily numb toes, a feeling like walking on a small pebble under the ball of the foot, that the sock is wrinkled under the ball of the foot, or that the shoelaces have come untied.

These symptoms start off slow and mild and gradually get worse and worse. Those are all warning signs that something is wrong. The nerves are sending signals that they are under attack and need help. All of this nerve damage is occurring regardless of other health issues which can also add to an unhealthy nerve, but this nerve trauma has to be reversed.

Let’s get into the specifics of why nerve compression and elongation are a bad thing.

When a nerve is compressed, it causes harm in several ways. First, there is liquid within the nerve that helps to wash away all of the waste materials that are produced to “feed” the nerves so that they can function. Compression of the nerve blocks that liquid from flowing to wash the waste material away. There is a buildup of waste material and it becomes toxic destroying the nerve cells within. Compression of the nerve also damages the cells.

Think about tapping your finger on the tabletop.

The cells are being compressed, they are going to get angry and cause pain, but if ignored, the skin cells will form a protective callus. That’s what happens within and outside of the nerve. The nerve gets bigger in diameter which only causes more nerve disease because the thicker nerve is within a tunnel that cannot expand. It’s like there’s a callus under your foot because you are walking on a stone. The skin forms thicker skin for self-protection but the stone is still pressing on the thicker skin which causes the skin to get even thicker. It is a self-destructive cycle.

The second factor is the elongation of the nerve.

When the nerve is stretched, the nerve function is altered. There is a stretched nerve that is then compressed at the same time. And we wonder why the nerve gets diseased!

Effect of ankle bone Alignment on the Nerve Tunnel

Foot with normal and compressed nerve tunnel

Nerves outside of the spine have a self-repair kit. Some cells attack the unhealthy, diseased cells, and others form new, healthier nerve cells. A major situation arises when the repair-kit cells are trying to do their job only to be complicated with more and more diseased cells. This is why it is extremely urgent to internally fix this condition before permanent nerve damage occurs. There is a point of no return when so much nerve damage has occurred that it can never be fixed.

How do I know if my nerve is being damaged because of ankle bone instability?

The first test is to have someone push along the course of the nerve starting behind the inner ankle as the nerve travels into the bottom of the foot. Pressure should be applied starting above the inner ankle bone and steps wise pushed until the arch area. Normally a person would just feel pressure. If pain is present, that is a positive sign the nerve is damaged within the tunnel.

Nerve pressure test to determine if the nerve has been the victim of the repeated micro-trauma

The second step would be to test the stability of the ankle bone while sitting and also standing and walking.

That can be confusing but those observations would be confirmed by having standing x-rays taken of your ankle bone. There should be a minimum of 2 views; the side and top to bottom. On the side view, you will either see an opening or closure of the naturally occurring space between the ankle and heel bones, the sinus tarsi. The angle of the ankle bone alignment should also be observed. On the top-to-bottom view, the angle of the ankle bone should be analyzed. The horizontal bisection of the ankle bone should extend into the first metatarsal bone. If it turns inward to the first metatarsal, then ankle bone instability is present.

Why is plantar neuropathy a “bad” thing?

The symptoms associated with nerve disease, neuropathy, are not life-threatening.

They are going to eventually have a severely negative impact on the quality of life and the mental health of the person with this condition because this is a progressive disease; it will never get better on its own without physical intervention. What’s worse is that this condition is downplayed and basically the majority of physicians are just masking the symptoms. Pain pills and other medications are given to shut down the warning signals of the trauma that are being inflicted on the nerve.

The psychological impact of this disease process cannot be ignored. Imagine living with a condition that is completely controlling your life. You can have both pain and numbness; the kind of sharp shooting, unrelenting, never-ending pain that can get to the point where you want to see if your nerves can just get cut out.

The big scare comes when there is a complete loss of feeling to the bottom of the foot. The foot is at risk of developing an ulcer and this is one of the biggest worries of diabetic patients. They are told to walk for exercise to help lower their blood sugar levels. This is the worst thing someone with no feeling to the bottom of their feet should be told. Once an ulcer is formed, it will take a while to heal but given the right wound care, it will eventually heal. The bad news is that it is only a matter of time until the ulcer reoccurs because the same reasons why the ulcer developed in the first place are still there.

Not to be over-dramatic, but the biggest worry of someone who loses feeling to the bottom of their feet is not an ulcer forming. Rather, it is that an ulcer had gotten so deep and severe that the leg has to be amputated. Unfortunately, this happens way too often.

What is the best way to treat plantar neuropathy?

The best treatment of any condition is to discover the root cause of that condition and fix/eliminate/reduce that cause as much as possible.

Otherwise, if the treatments are focused on the symptoms but the underlying cause is never fixed, then those symptoms will keep reoccurring.

When someone starts to develop nerve-related symptoms to their feet, the first place to look is at the stability or instability of their ankle bone. Yes, of course, there are going to be many other places that a physician must take into consideration but let’s rule out the most obvious cause first. If ankle bone instability is present, it has to be stabilized. The other forms of treatment will be ineffective if the ankle bone is allowed to continue to partially dislocate on the heel bone. It’s like putting air in the tire of a car that has a hole in it. The air will leak out of the tire and it will go flat again.

There is a nerve disease staging that will determine the best course of action. If there are only mild, occasional symptoms, then the first step is to insert HyProCure after making sure you are a candidate. That will prevent the compression and elongation of the nerve. Nerves can heal themselves if given the right conditions. The more internal nerve damage, the longer it will take for the nerve symptoms to go away and for the nerve to heal. There are no other methods of treatment other than HyProCure that have been scientifically shown to decrease the compression and elongation of the nerve within the tarsal tunnel.

HyProCure decrease the compression and stain to the nerve

Effect of HyProCure on Ankle Bone Alignment and Nerve Function

If someone has nerve symptoms all the time, then the combination of HyProCure plus a tarsal tunnel decompression is needed. Creating an opening in the tunnel instantly decreases the forces acting on the nerve. Surgeons have seen the benefits of performing a decompression of a tarsal tunnel for many decades. The problem, though, was that surgeons only opened up and freed the nerves within the tunnel but they never addressed the ankle bone instability. So, when we examine the scientific evidence of tarsal tunnel decompression without stabilizing the ankle bone, the results are not very good.

It should go without saying that additional treatments should be given to speed and facilitate nerve healing after the underlying cause is addressed. Of course, if someone is a diabetic then all efforts to maintain a healthy blood sugar level are necessary. If there are vitamin deficiencies or other issues, they all need to be addressed.

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