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The causes of Neuropathy and the little known tricks to reduce the symptoms.The top natural, but highly effective, ways to reduce the pain, numbness and burning. From diabetes to vitamin deficiencies – there are a number of potential threats to your nerves. For cancer patients undergoing chemotherapy treatment, the risk of peripheral neuropathy is greater.
For many – the symptoms of their peripheral neuropathy will subside once treatment is over.
Source: Cancer Related Neuropathies InfoGraphic – An infographic by the team at The Neuropathy created this great InfoGraphic, Please share it! In addition to medications used to treat cancer – other types of medications have been linked to the development of neuropathy. While doctors and pharmacists will do their best to keep you informed of potential side effects of medications, it is important that you do your own research. You wouldn’t think nutritional deficiencies would be much of an issue in countries such as the United States – but surprisingly – there are a number of common deficiencies in the U.S. In addition to the various negative health outcomes mentioned above, some nutritional deficiencies pose a threat to the health of your nerves.
Of these – Vitamin B12 deficiency plays the biggest part in development of neuropathic pain. For those suffering from diabetic neuropathy – vitamin D is an important vitamin for combating your diabetes and slowing the progress of your neuropathy. A more silent threat to your nerves is consistent, repeated pressure or compression of nerves or nerve tissue. For example, sitting for long periods of time can put pressure on the nerves as well as cut of circulation to your feet – depriving the peripheral nerves of the life-sustaining oxygen and nutrients that blood delivers.
According to the latest data from the Centers for Disease Control (CDC), 51.4 million inpatient surgical procedures were performed in the United States last year. If you suffer from an autoimmune disease – you may be at greater risk of developing neuropathy. While not all threats to your nerves can be prevented – knowing what the threats are can help you take steps to minimize your risk and be better prepared to recognize the cause or source of your neuropathy. How has knowing the cause of your neuropathy helped you and your doctor develop an effective treatment plan?
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Diabetes is a condition that affects many areas of the body, including a patient’s feet, legs and hands. Most cases of diabetic peripheral neuropathy can be traced back to uncontrolled blood sugar. Neuropathy can be very painful, but the condition generally starts with a slight tingling or numbness in the legs, feet or hands.
The best thing a diabetic can do to rebuild muscle and keep new nerves healthy is to adopt a healthier lifestyle. Physical therapy is another option available to diabetics suffering from leg, arm or foot pain. Serving Beverly Hills, Los Angeles, Encino, Studio City, Sherman Oaks, Tarzana, Malibu, Calabasas, Santa Monica, Pacific Palisades, Reseda, Northridge, Woodland Hills, West Hills, Granada Hills, Porter Ranch, Sylmar, and the surrounding areas. Tufts OCW material is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License. Pathology leading to amputation - Physiopedia, universal access to physiotherapy knowledge. Worldwide prevalence estimates of amputation are difficult to obtain, mainly because amputation receives very little attention and resources in countries where survival is low[1]. Peripheral Vascular Disease is also known or referred to as Peripheral Artery Disease or lower extremity occlusive disease. The peripheral vascular system consists of the veins and arteries beyond or distal to the chest and abdomen supplying the arms, hands, legs and feet. Atherosclerosis, which is the process of Peripheral Arterial Disease (PAD), affects several arterial beds including the coronary and peripheral circulation[5].
Diabetes is also another condition that has an effect on the pathology that may lead to lower limb amputation.
Diabetes Mellitus (Type 2)  Diabetes mellitus is also present in almost half of all cases, and people with diabetes mellitus have a 10 times higher risk of amputation[6]. Patients who suffer from Diabetes Mellitus are at a high risk of developing ulcers and associated complications.[9] Studies indicate that diabetic patients have up to a 25% lifetime risk of developing a foot ulcer[10].
Neuropathy in diabetic individuals affects the motor, sensory and autonomic components of the the nervous system.
In the case of peripheral circulation where the the arteries of the lower limbs are affected, pain and tissue damage develop which may eventually lead to amputation in some cases. Peripheral arterial disease is one contributing factor to ischaemia involving the lower limbs.
Tissue viability is affected not only by internal factors such as PAD or Diabetes Melllitus but also by external stimuli such as smoking. Lower limb amputation can also occur due to systemic infections such as bacterial infections. Learn about the shoulder in this month's Physiopedia Plus learn topic with 5 chapters from textbooks such as Magee's Orthopedic Physical Assessment, 2014 & Donatelli's Physical therapy of the shoulder 2012.
Symptoms of peripheral edema include swelling of the affected area(s), which causes the surrounding skin to "tighten." The swelling from peripheral edema is gravity-dependent (it will increase or decrease with changes in body position). In the case of pulmonary edema, there is often no evidence of fluid retention or noticeable swelling on examination of the patient's extremities.
Lymphedema is the swelling of one or more of the legs and arms caused by poor function of the lymphatic system. Read What Your Physician is Reading on Medscape Congestive Heart Failure and Pulmonary Edema »Congestive heart failure (CHF) is an imbalance in pump function in which the heart fails to adequately maintain the circulation of blood. Ankle swelling is a serious problem which is faced by many people at some point of time in life.
An individual may not be able to move his or her leg due to pain and swelling in the ankle. The above discussion clearly reveals the most common factors responsible for ankle swelling. Deep venous thrombosis (DVT) and its sequela, pulmonary embolism (PE), are the leading causes of preventable in-hospital mortality in the United States. The earliest known reference to peripheral venous disease is found on the Ebers papyrus, which dates from 1550 BC and documents the potentially fatal hemorrhage that may ensue from surgery on varicose veins. The Virchow triad of venous stasis, vessel wall injury, and hypercoagulable state is still considered the primary mechanism for the development of venous thrombosis. In practical terms, the development of venous thrombosis is best understood as the activation of coagulation in areas of reduced blood flow. The current diagnostic and therapeutic management of DVT is strongly influenced by the different risks assigned to proximal and calf vein thrombi. The exact incidence of DVT is unknown because most studies are limited by the inherent inaccuracy of clinical diagnosis. In hospitalized patients, the incidence of venous thrombosis is considerably higher and varies from 20-70%.
Death from DVT is attributed to massive PE, which causes 200,000 deaths annually in the United States. The signs and symptoms of DVT are related to the degree of obstruction to venous outflow and inflammation of the vessel wall. Tenderness occurs in 75% of patients but is also found in 50% of patients without objectively confirmed DVT. Clinical signs and symptoms of PE as the primary manifestation occur in 10% of patients with confirmed DVT. The pain and tenderness associated with DVT does not usually correlate with the size, location, or extent of the thrombus.
No single physical finding or combination of symptoms and signs is sufficiently accurate to establish the diagnosis of DVT.
Tenderness, if present, is usually confined to the calf muscles or along the course of the deep veins in the medial thigh. Discomfort in the calf muscles on forced dorsiflexion of the foot with the knee straight has been a time-honored sign of DVT.
The Homans sign is found in more than 50% of patients without DVT and, therefore, is nonspecific.
Superficial thrombophlebitis is characterized by the finding of a palpable, indurated, cordlike, tender, subcutaneous venous segment.
Patients with superficial thrombophlebitis extending to the saphenofemoral junction are also at higher risk for associated DVT. Painful white inflammation was originally used to describe massive ileofemoral venous thrombosis and associated arterial spasm.
The physical findings may suggest acute arterial occlusion, but the presence of swelling, petechiae, and distended superficial veins point to this condition. The clinical evaluation of patients with suspected DVT is facilitated by an assessment of risk factors.
The clinical assessment of patients with suspected DVT is often difficult because of the interplay between risk factors and the nonspecific nature of the physical findings.
The primary treatment for diabetic foot pain is to bring blood glucose levels within the normal range. Medication can be administered for wounded or infected feet or if the doctor suspects risk of infection.
There are many things which aid diabetes foot pain treatment and delay worsening of the damage. A suited diet can also take care of foot (and nerve) pain by emphasizing on blood sugar control. Antidepressants have the ability to deal with both pain and depression and can be used as a part of diabetic foot pain treatment. Changing a therapy can, sometimes, be a helpful technique in combating foot and nerve pain. The peripheral nervous system is especially prone to threats as the nerves stretch long distances to your outermost extremities – leaving them more vulnerable to damage. Elevated blood sugar – if left unmanaged – damages nerve fibers and blood vessels, resulting in neuropathic pain or numbness. Chemotherapy and other drugs used in cancer treatment can damage the peripheral nerves – resulting in chemotherapy-induced neuropathy.


For example, some medications used to fight infections (including the antiretroviral agents used to treat HIV) can lead to complications of neuropathy. It is also important to be keenly aware of the effects medications are having on your body.
A few deficiencies commonly linked to neuropathy are deficiency of vitamin B12, vitamin B2, vitamin D and Magnesium. Vitamin B12 is an essential vitamin for the health of the myelin sheath – a protective layer of fat around the nerves.
Studies have shown that individuals lacking in vitamin D are more likely to develop diabetes. Alcohol consumption inhibits the absorption of certain vitamins and nutrients into the blood stream.
Damage can be caused by inadvertent cutting of nerve tissue, inflammation on or around the nerves, extended contact between nerve tissue and surgical tools or equipment, stretching or compression of nerve tissue and more. According to the Mayo Clinic, trauma such as “motor vehicle accidents, falls or sports injuries can sever or damage peripheral nerves.” While you can’t always prevent accidents such as this – make sure to notify your doctor immediately if you experience any of the symptoms associated with nerve pain. As mentioned previously in this article – exposure to toxins from cancer treatment and other medications can cause neuropathy. According to the Mayo Clinic, the autoimmune diseases most commonly associated with neuropathy include Sjogren’s syndrome, lupus, rheumatoid arthritis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy and necrotizing vasculitis. Knowing the cause of your neuropathy can – in some cases – provide you with the knowledge you need to begin making changes to slow or even halt the spread of damage.
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Diabetics who suffer from numbness, pain and loss of sensation in the extremities have what is called peripheral neuropathy. It is estimated that over half of the patients diagnosed with diabetes will experience peripheral neuropathy at some point in their lives. Vocational, occupational and physical therapists can work with patients to rebuild muscle and help them find solutions to everyday problems stemming from physical limitations. This means that those who are just now experiencing the early symptoms will have the best outcome from treatment. Early symptoms are often ignored; however, it is important to act quickly to limit nerve damage. It affects the peripheral vascular system, mostly the arteries, and is a manifestation of systemic atherosclerosis and atherothrombotic conditions which may include stenotic, occlusive and aneurysmal disease[4]. It may be referred to as hardening of the arteries where there is generalised degeneration of the elastic tissue and muscles composing the arterial system.
It is characterised by chronic compensatory hyperglycaemia that results from progressive insulin resistance especially in muscle tissue together with insufficient pancreatic secretion of insulin to aid glucose uptake in tissues [7]. Peripheral neuropathy and ischaemia from Peripheral vascular disease are two contributing factors to the development of foot ulcers. Autonomic neuropathy causes the reduction in sweat and oil gland function with the foot loosing its natural ability to moisturise the overlying skin.
Patients suffering from peripheral arterial disease present with pain referred to as Intermittent Claudication. The latter is one of the causal factors when amputation of the affected lower limb may be considered.
Smoking is considered to be another or an added risk factor for lower limb amputation due to its effect on the circulation and potential for healing. Previously healthy individuals when affected by such infections are at a risk of amputation of limbs not only as a treatment of choice but also as a life saving measure. In order to facilitate scientific communication the International Organization for Standardization (ISO) developed a system of accurate classification. 2005, Major lower limb amputations in the elderly observed over ten years: the role of diabetes and peripheral arterial disease. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider.
For example, if a person is lying on their back (supine), the swelling will not appear in the legs, but will appear in the area around the sacrum. Any kind of injury in the ankle should not be ignored and reported to the doctor immediately, so as to prevent the ankle to swell. Gout is a condition associated with excessive build up of uric-acid crystals inside the ankle’s fluid. This problem occurs due to improper flow of blood in both legs. Chronic ankle swelling is mostly observed in people suffering from peripheral edema. Improper blood flow causes blood clotting, which eventually leads to swelling in the ankle and the foot. The understanding about the ankle swelling causes would help to treat the problem in an effective way. Although PE itself is discussed in other articles, it occurs primarily as a complication of DVT. In 1644, Schenk first observed venous thrombosis when he described an occlusion in the inferior vena cava.
This explains why the most successful prophylactic regimens are anticoagulation and minimization of venous stasis.
The propagation and organization of the venous thrombus usually result in destruction of venous valves and produce varying degrees of venous outflow obstruction.
More importantly, most DVT is occult and usually resolves spontaneously without complication. Venous ulceration and venous insufficiency of the lower leg, which are long-term complications of DVT, affect 0.5% of the entire population.
Forty percent of patients with superficial thrombophlebitis without coexisting varicose veins and with no other obvious etiology (eg, intravenous catheters, intravenous drug abuse, soft tissue injury) have an associated DVT.
High fever is usually indicative of an infectious process such as cellulitis or lymphangitis. This ischemic form of venous occlusion was originally described as phlegmasia cerulea dolens or painful blue inflammation. The diagnosis of DVT is confirmed in only 20-30% of ED patients with clinically suspected DVT. Clinicians have observed that a discordance is often present between the clinical assessment and the results of objective testing. The model enables physicians to reliably stratify their patients into high-, moderate-, or low-risk categories. If antibiotics are prescribed, take the entire course even though positive results can appear within two to three days only.  For treating painful diabetic neuropathy, Cymbalta and Lyrica are the FDA-approved medications. Diabetic foot treatment can also be done at several wound care centers which focus on the lower extremity wounds and ulcers. Debridement of the wound through surgery, improvement of circulation and special dressings can be some of the other treatment procedures.
Routine examination of the feet helps identify any damage even though it is trivial. In case of any injury, attend to it immediately as even a small injury can create havoc for the foot.
It is good to lower blood sugar and consequently manage diabetes complications like foot pain.
Apply a water-based moisturizer regularly to prevent cracking but avoid using it between your toes.
Lidocaine or capsaicin containing creams may prove useful in controlling pain to certain extent.
Even if there is absence of clinical depression in a patient, doctors may prescribe antidepressants to cater to foot pain and other nerve pain. A study pointed out that insulin injections used for glucose control can reduce the likelihood of neuropathy. Another technique which can be helpful in diabetes foot pain treatment is the Dellon procedure. The function of your peripheral nerves is to connect your brain to your extremities – allowing them to communicate with each other. While some threats can’t always be avoided – other threats can be avoided or minimized if you know about them beforehand.
In fact, diabetes is the leading cause of neuropathy in the United States with approximately 70% of all diabetic patients developing symptoms of neuropathy. An estimated 30-40% of patients undergoing chemotherapy will develop peripheral neuropathy. Other potential threats include anti-seizure medications and various heart and blood pressure medicines.
If you begin to notice adverse side effects such as numbness, tingling or nerve-related pain – let your doctor know immediately. Poor dietary choices are usually the culprit, leaving us deprived of important vitamins and nutrients.
A deficiency of B12 can lead to degeneration of this protective coating – leaving the nerves more vulnerable to damage.
Those who have been diagnosed with diabetes and suffer from low vitamin D levels are more likely to develop complications such as neuropathy. These can include sitting for long periods of time, typing or other repetitive motions that put stress on the nerves, poor posture and more. This – combined with the poor dietary choices associated with alcoholism – can lead to nerve damaging vitamin and nutritional deficiencies.
The sensitivity is gone and I’m so grateful for your product and what it has done for me. All of our testimonials are from real customers who saw real results but your results can vary greatly depending on many factors. Patients should also stop smoking because it constricts blood vessels that should be feeding nutrients to peripheral nerves. Peripheral Vascular Disease is the most common cause of limb loss overall[2], with the rate of dysvascular amputation being nearly 8 times greater than the rate of trauma related amputations, the second leading cause of limb loss[3].
This tissue is replaced by fibrous tissue and the elastic vessels become harder with stretching of collagen and calcium depositing in the walls of the arteries causing them to become hard and tortuous. Diabetes Mellitus usually has an insidious onset and presents as persistent hyperglycaemia. Once a foot ulcer develops there is a high risk of wound progression that may lead to complications and amputation. The innervation of the intrinsic muscles of the foot is affected and damage leads to an imbalance between the flexors and extensors of the affected foot and therefore causing anatomic deformities. The skin becomes dry and susceptible to tears or breaks with subsequent development of infection. Neuropathy (with alterations in motor, sensation, and autonomic functions) plays the central role and causes ulcerations due to trauma or excessive pressure in a deformed foot without protective sensibility. It has a detrimental effect on wound healing due to the local and systemic processes that nicotine has[15]. Infections include: Meningococcal Meningitis, Staphylococcus and MRSA infections and Necrotizing Fascitis.


Whereas no other treatment but surgery is currently available for chondrosarcomas, osteosarcomas show an approximately 50–80% response rate to adjuvant chemotherapy. The mentioned classification is constructed on an anatomical bases due to a failure of formation.
The skin over the swollen area appears tight and shiny, and often when pressure is applied to the area with a finger, an indentation appears.
It is important to treat the swelling and inflammation in the ankle as soon as possible, so that the problem does not aggravate. At times, an individual may also suffer from a fracture in the ankle due to stress and tension, consequently resulting in swollen ankle. Obesity and pregnancy are the two major factors resulting in peripheral edema, eventually resulting in swollen ankles. With the help of using ankle wraps, exercising the ankles in a gentle way, eating nutritious foods and applying cold packs on the ankle, ankle swelling would be treated to a great extent. The formation, propagation, and dissolution of venous thrombi represent a balance between thrombogenesis and the body’s protective mechanisms, specifically the circulating inhibitors of coagulation and the fibrinolytic system.
DVT of the lower extremity usually begins in the deep veins of the calf around the valve cusps or within the soleal plexus. Furthermore, studies have suggested that isolated calf vein thrombi are smaller and do not cause significant morbidity or mortality if they embolize.
Spontaneous lysis and complete recanalization of established proximal DVT occurs in fewer than 10% of patients, even with anticoagulation.
Existing data that underestimate the true incidence of DVT suggest that about 80 cases per 100,000 persons occur annually.
Extrapolation of this data reveals that as many as 5 million people have venous stasis and varying degrees of venous insufficiency.
Many thrombi do not produce significant obstruction to venous flow; venous collaterals may develop rapidly, and venous wall inflammation may be minimal. The prevalence of DVT in the ED patient population correlates with the number of risk factors present. For example, patients deemed to be at high risk for DVT may have a negative finding on duplex ultrasonographic study.
Combining this with the results of objective testing greatly simplifies the clinical workup of patients with suspected DVT. Unattended feet can become problematic and painful, sometimes, leading to amputation as well.
Although blood glucose control can worsen symptoms initially, over time, this helps in reducing the symptoms. In case of a severe infection, the doctor can advice hospitalization as giving pills may seem ineffective. High impact exercises may not suit all, particularly when you have lost sensation in the feet.
Remembering everything can be cumbersome, so concentrate on the major factors contributing to good glucose control. As far as over the-counter medications are concerned, ibuprofen, naproxen and aspirin may be useful. In many cases the symptoms of neuropathy will subside once you stop taking the medication – but it is important to address the problem sooner rather than later. Nutritional deficiencies can have a variety of effects on your health; including increased levels of fatigue or weakness, soreness, bruising, type 2 diabetes, high blood pressure, memory loss and much more. As such, getting enough vitamin D either through exposure to the sun or from food or dietary supplements is hugely important for those with diabetes or diabetic neuropathy.
For those already suffering from neuropathy, alcohol consumption should be limited to prevent an acceleration of your symptoms. As the muscles weaken, patients may be more likely to lose their balance when standing or walking.
On analysing causal pathways for diabetic lower-limb amputation foot ulcers preceded around 84% of amputations[11]. Such deformities include the toes being pulled up into a hammer toe or claw foot flexion deformity. Minor trauma is also a contributing factor to ulcers that may eventually lead to amputation. Once the protective layer of skin is broken, deep tissues are exposed to bacterial colonization. It is the first method of choice for arterial stenosis and occlusion, and for venous incompetence[14]. Nicotine being a vasconstrictor reduces the blood flow to the skin and thus causes tissue ischaemia together with an impairment in the healing process. Examples of traumatic injuries include: compound fractures, blood vessel rupture, severe burns, blast injuries, stab or gunshot wound, compression injuries and cold trauma[16].
Surgical removal of these tumours is currently mostly performed with limb salvage, but amputation may be required in some cases. A Review of Pathophysiology, Classification, and Treatment of Foot Ulcers in Diabetic Patients.
In order to treat the swelling in ankle, it is first important to learn about the causes of ankle swelling.
A minority of cases arise primarily in the ileofemoral system as a result of direct vessel wall injury, such as from hip surgery or intravenous catheters.
The process of adherence and organization of a venous thrombus does not begin until 5-10 days after thrombus formation. Contradictory evidence from several other studies has indicated that isolated calf vein thrombi do embolize, suggesting that proximal propagation may occur rapidly and that fatal PE arising from isolated calf vein DVT is a significant risk. These factors are the most important pathogenic mechanisms in the development of chronic venous insufficiency. In this case, the probability of DVT is still greater than 20% when the known sensitivity, specificity, and negative likelihood ratio of duplex ultrasonography are considered. The Wells clinical prediction guide incorporates risk factors, clinical signs, and the presence or absence of alternative diagnoses.
Besides taking care of your existing problem, the specialist can also provide an excellent resource for how to care for your feet on daily basis. If you do not have cuts or wounds, bathing and walking may be helpful in reducing foot pain. But remember that over-the-counter pain medicines may not work well can pose (serious) side effects as well. Patients who have debilitating peripheral neuropathy in the legs and feet may require a wheelchair, leg braces or splints.
Foot ulcers are considered to be reasonably common and they not only affect the patient's funtional status and well being but can also identify individuals who may be at a higher risk of amputation.
These will cause abnormal bony prominences and pressure points, such as on the tops of the toes or under the metatarsal heads, which may eventually lead to skin breakdown and ulceration. Individuals suffering from peripheral vascular disease and diabetic peripheral neuropathy experience a loss of sensation that may exacerbate the development of ulcers. Infection is facilitated by DM-related immunological deficits, especially in terms of neutrophils, and rapidly progresses to the deep tissues.
In individuals suffering from PAD the blood flow in the lower limbs is reduced due to processes causing stenosis. Ultrasonic imaging is non-invasive and can provide clinical information about the site and severity of narrowing of arterial vessels or of any blockages of main vessels. Nicotine also promotes an increase in the level of platelet adhesiveness which in result raises the risk of thrombotic microvascular occlusion leading to further tissue ischaemia[15].
In cases of traumatic injury amputation of the limb is considered either as a life saving procedure or where the limb is so severely injured that reconstruction will be less functional than amputation. In addition, the tumours have a risk of local recurrences adversely affecting the prognosis compared to the primary tumour".[17]. Transverse Deficiencies resemble an amputation residual limb, where the limb has developed normally to a particular level beyond which no skeletal elements are present. Over the last 25 years, the pathophysiology of DVT has become much better understood, and considerable progress has been made in its diagnosis and treatment. Studies have repeatedly documented this inherent difficulty of the clinical diagnosis of lower extremity DVT.
Having an objective method to determine pretest probability would simplify clinical management. Diabetic foot pain treatment may also be dealt with shoe inserts, removal of calluses, etc.
In peripheral arterial disease there is build up of fatty deposits in the walls of the arterial system. Many times diabetic individuals are unable to detect trauma to an affected area such as the foot. Blood circulation is usually sufficient when one is at rest, however when one starts walking and the demands are greater the blood supply is not sufficient to the lower limb muscles causing cramps and pain.
Where multiple stenoses are present such imaging can determine which stenosis is causing more restriction to blood flow[14]. In the case of trauma limb amputation can also take place months or years after the actual trauma when reconstructive procedures or healing hava failed. These fatty deposits, also known as atheromas, cause a reduction in the lumen of the arteries. In diabetic individuals the hyperglycaemic-induced metabolic abnormalities cause a conversion of intracellular glucose to sorbitol and fructose. This may result in injury with wounds either going unnoticed or progressively worsen when the affected area is exposed to repetitive pressure or forces such as shear forces during ambulation[12][11].
Thus such pain gets worse with greater demands example: when walking uphill and improves or is relieved after a short rest[13]. The reduction in the lumen causes stenosis and restricts the blood flow and supply to the particular area affected. The accumulation of these sugars cause a reduction in the synthesis of products required for normal nerve conduction and function. Poor healing of such wounds, due to compromised circulation, will eventually lead to amputation of the involved limb. The chemical conversion of glucose will also increase the oxidative stress on nerve cells and lead to further ischaemia and thus causing further nerve cell injury and death.
The skin surface is located at the top of the image whilst markers on the right indicate depth in cms.



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