Peripheral neuropathy is a general term that refers to nerve diseases that impact the nerves outside your brain or spinal cord and cause numbness, weakness, or pain, usually in the hands and feet. These conditions can result from traumatic injuries, vascular and blood problems, autoimmune diseases, hormonal imbalances, kidney and liver disorders, nutritional or vitamin imbalances, alcoholism, exposure to toxins, certain cancers and tumors, chemotherapy, or infections. One of the most common causes of peripheral neuropathy is diabetes.
As a podiatrist, you no doubt frequently see patients who are at risk for developing neuropathy or are complaining of signs and symptoms of neuropathy. Symptoms vary depending on the type of nerves that are damaged – motor, sensory, or autonomic. Symptoms may range from mild to severe. While podiatrists may or may not treat the underlying cause of peripheral neuropathy depending on the podiatrist’s scope of practice, they do have a significant role to play in improving the patient’s quality of life and optimizing patient outcomes.
Identify and Monitor Patients Who Are at Risk for Developing Peripheral Neuropathy
By obtaining a thorough patient history, you can identify patients who are at risk for developing peripheral neuropathy. If a patient is at increased risk, educate the patient about their risk factors and measures they can take to reduce their risk of developing peripheral neuropathy, such as controlling their diabetes or hypertension, losing weight, smoking cessation, or reducing alcohol consumption. Also educate them on signs and symptoms to be aware of, and the importance of early diagnosis and treatment. All patient education should be documented in the patient’s medical record. Periodically monitor patients at risk for developing peripheral neuropathy and document the presence or absence of signs and symptoms.
Recognize Signs and Symptoms of Peripheral Neuropathy
When reviewing the patient’s history and performing a physical examination, be cognizant of any possible signs and symptoms of peripheral neuropathy. If signs and symptoms are present, perform diagnostic tests to rule out other conditions or confirm the presence of peripheral neuropathy. If you are uncomfortable performing the necessary tests, refer the patient to another healthcare provider for evaluation. If you refer the patient for testing, be sure to communicate the reason for your referral to the referral physician. Document your rationale for diagnostic testing or referral.
Promptly Treat and Manage Peripheral Neuropathy
Once a diagnosis of peripheral neuropathy has been made, promptly initiate appropriate treatment. Patients with poorly managed peripheral neuropathy are more likely to develop complications such as foot ulcers which may lead to infection and amputation. Poorly managed patients may also have a poorer quality of life if they have pain and burning in their feet, loss of balance, or limited mobility. Your treatment of the patient and your rational for your treatment decisions, along with any patient education and instructions should be clearly documented in the patient’s medical record.
Optimize Treatment of the Patient
It may be necessary to co-manage a patient with other healthcare providers, such as a neurologist, endocrinologist, nutritionist, or others to provide optimal care of the patient. When multiple healthcare providers participate in the treatment of a patient, communication (and documentation of that communication) is vital so that all parties are aware of who is treating the patient and for what they are treating the patient. It also reduces the risk that a patient will “fall through the cracks” and not receive appropriate treatment.
By diagnosing and treating peripheral neuropathy in a timely manner and providing ongoing monitoring and management of peripheral neuropathy, you will improve patient outcomes and satisfaction. You will also reduce your risk of a lawsuit by a patient alleging they suffered damages resulting from failure to diagnose peripheral neuropathy, delay in diagnosing peripheral neuropathy, failure to treat (or refer for treatment) peripheral neuropathy, or other allegations.
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The information contained on the PICA Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. All information contained on the blog is subject to change.
