A. Neuropathy is a nonspecific term that means disease of nerves.  Nerve diseases lead to disturbances of sensations and/or to weakness of muscles.

a) Mono-Neuropathy is the disease of one nerve.  A common example is the Carpal Tunnel Syndrome where the Median Nerve is trapped at the wrist leading to numbness and weakness of the hand on the side of the thumb.  It often wakes up one from sleep and is relieved by shaking the hand.  When it becomes severe, it may require injections or surgery to free the trapped Median Nerve.

b) Peripheral Neuropathy is disease of the ends of the long nerves that supply the edges of the body.  A common example is Diabetic Neuropathy where, due to chronic high sugar, the nerve endings are progressively damaged.  Patients begin to feel numb in the feet and this numbness climbs up the legs and may also involve the hands and arms.  With the numbness come foot ulcers and joint deformities due to diminished position sensations.  The best treatment is preventive, which is to keep diabetes in good control at all times.

c) Neurogenic Claudication means that the longer one walks, the more numb, more painful, and more weak one’s leg muscles become until one is forced to stop walking.  This condition is caused by entrapment of the nerves in the bony canals of the vertebral column after they emerge from the spinal cord.  These spinal bony canals can narrow down with time until they start to choke the emerging nerves.  Because this choking is made worse by walking, it causes the syndrome of neurogenic claudication, which reverses after one sits down and rests his legs a while.  Again, blood supply to the legs is usually good.

d) Neuralgia means nerve pain.  The causes are numerous but the common causes are few.  Trigeminal Neuralgia, for example, is face pain generated by the Trigeminal Nerve, which comes out of the brain and supplies the face with sensation.  The pain is sharp, electric, and comes in flashes if the face is touched or moved.  Post Zoster Neuralgia is the regional nerve pain that follows a shingles attack and may last for weeks, months, or years.

B. Arterial Insufficiency or poor blood supply is caused by clogged arteries.  The feet may become ischemic (lacking in oxygen), pale, cold, and pulseless.  Walking is limited by the diminished blood supply, which causes a syndrome known as Intermittent Claudication. 

a) Intermittent Claudication is similar to Neurogenic Claudication because the feet and leg muscles become painfully sore and weak the longer one walks until one is forced to stop and rest.  Here, unlike neuropathy, the nerves are intact but the blood supply and arterial pulses to the feet are impaired.

b) Ischemic Ulceration of the feet is caused by poor blood supply, which causes the skin over pressure points to develop necrosis and gangrene.  The toes and feet may turn black and become mummified.  Amputations may be the only option unless the blood supply can be reestablished with surgical bypass or stenting.  Arterial pulses cannot be detected on examination of the feet.

 C. Venous Insufficiency is caused by damaged veins.  The function of veins is to return blood from the body to the heart.  Blood is propelled by muscle movements and the blood flow is directed centrally by valves strategically placed inside the veins.  However, when the valves become damaged or when the veins become so dilated that they prevent the valves from locking, Venous Insufficiency occurs.

a) Varicose Veins are the commonest cause of Venous Insufficiency to the legs.  When the Venous Insufficiency becomes severe, venous ulcers may develop on the calves, shins, or feet.  Below-knee support hose that limit venous dilatation can help stabilize the condition.

b) Post Phlebitis Venous Insufficiency occurs, as the name implies, after the leg veins are attacked by blood clots.  Blood clots destroy the vein valves, which protect the central blood flow.  The absence of valves promotes back flow of the blood, which leads to swelling and ulceration of legs and feet.  Below-knee support hose and blood thinners are the main treatments.

Dr. Hanna Saadah