As Pedorthists, we have always worked with clients who have neuropathy. For the most part, these people have usually had Diabetes or impairment of sensation from injuries or surgeries. In the past few years, we have seen increasing numbers of people with what is commonly called ‘idiopathic neuropathy’, which means no known or obvious cause. This lack of diagnosis makes people frustrated as there is no clear treatment plan to cope with or adapt to the problem.
Having experienced this, myself, I have put a fair amount of energy into things I can do to try and reduce the impact on my daily life. Part of the problem is the host of symptoms associated with loss of sensation.
Many have pain, but the pain can be burn-like, sharp electrical or just continual aching. Sometimes, it will be all the time or occasional and inconsistent. Many have no pain at all, just spotty or complete loss of sensation.
The one thing that is constant is how it affects our balance. Nerve receptors in the soles of our feet give information to our brains to let us know where our feet are and how they are conforming to the surface we are standing or walking on. This is called proprioception, and to some extent, you can do exercises to try and enhance it. When sensation is impaired or delayed, it puts us at risk of a stumble or fall.
When we first become aware that there is a sensory deficit, we are more apprehensive about movement and tasks that we used to take for granted. This loss of confidence often results in reduced activity that will affect our quality of life on many levels.
When I am designing an Orthotic or Orthotic/shoe combination, I am trying to provide symptomatic relief for the problem I am confronted with, but there are other considerations. If we discover a history of neuropathy, then stability and fall prevention are more important. If, in examining the feet and legs, there are differences between left and right, then balance and reducing compensation are key. In truth, the main complaint is usually the result of how balance, posture and gait interact.
For people who have worked their lives on hard surfaces, perhaps in inappropriate or worn footwear, the neuropathy may be more a compression type where stationary standing does not allow enough tissue activity to assist blood flow.
Sometimes, symptoms are worse due to friction or movement of the feet in the shoe. Often, an orthotic to stabilize or a softer stocking to cushion the feet will help. Something I often see is shoes that are too soft or worn out, literally undermining you.
Another common problem is a trunk forward posture, where you are keeping an eye on your feet for confirmation of what your brain is not telling you. This puts your centre of gravity more towards your toes and makes your toes work harder than they should. Your centre of gravity should be under your ankles with your head up and shoulders back. This would be active alert posture.
For breath and balance, it takes conscious effort.