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Do You Have Some Nerve?

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Published: 17Oct2009
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Peripheral neuropathy, or the abnormal functioning of a nerve in the feet or ankles is becoming increasingly more prevalent in society. On a regular basis, I have individuals coming to our office to be evaluated for numbness, tingling, shooting pain, electrical shocks, feelings of cold, burning pain to the feet. Many of these individuals don't have diabetes (the most common cause of neuropathy in the United States), but still have the symptoms. They have neuropathy and often wonder how extensive it is our how many problems they may have from this neuropathy.

Over the years, many tests have been developed to help evaluate the nerves. A nerve conduction test is useful and can help people evaluate the functioning of the larger nerves. These tests, however, may be inconclusive for small nerve fiber damage as often seen in neuropathy. Vibration testing, light touch testing, temperature (hot-cold) testing and PSSD testing have all also been utilized to help in this respect. But they have varying results dependant on the physician performing the tests. So the question usually is how a patient can get the best results or best understanding of the extent of their disease and more importantly how they can evaluate improvements from various treatments.

A newer test, Epidermal Nerve Fiber Density testing, is a technique that allows the diagnosis of small fiber neuropathy with 97% accuracy. This is the analysis of a 3mm punch biopsies of the skin to count the number of nerve fibers and compare to the usual number. Since the skin is quite consistent in this respect, the value can be compared to the standard and confirm the presence of small fiber neuropathy. No other test is as accurate for small fiber disease.

The other great advantage of epidermal nerve fiber density testing is the ability to evaluate the improvement or regrowth of small nerve fibers after treatment is undergone for neuropathy. Comparing to the previous biopsy, treatments can be shown to be effective by more than just subjective measures. It doesn't just feel better, it really is better. This is of great value to showing the value of newer treatments to not just stop neuropathy symptoms but hopefully reverse the progression.

So as you suffer with your neuropathy and are told that you "probably" have neuropathy, this new test may be a great opportunity to quantify the presence or absence of neuropathy. Then you can work with a specialist to reverse these symptoms and return to normal life. In other words, you can optimize what you were born with!

Brandt R. Gibson, DPM, MS is a podiatrist with special interest in neuropathy and the new treatments. He is located in American Fork, Utah. For further educational materials and recommended medical products, visit http://www.UtahFootDoc.com . A free book on foot and ankle health can also be ordered at http://www.MyFeetHurtBook.com

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