Worsening foot pain

After being diagnosed as a T2 four years ago, with an HbA1c of 119, I immediately started a LCHF diet and saw my numbers tumble to 49 within a few months and thereafter stabilise around 39 to 41 (with one blip at 44). Last month it was 36 and I eat carefully to avoid spikes, with post meal blood sugar levels very rarely going over 7. During my first 2-3 years my figures were not quite so good, but even then were normally under 7.8 after meals. I was never obese and at diagnosis weighed about 15st 4lbs, not greatly overweight for my 6’4’’. I’m now 67 years old and have maintained a weight of about 13st (now 12st 8lb).

Ever since diagnosis I’ve been plagued with sore feet, especially toes, with only a small one area of numbness on the edge of my big toes. This made lengthy walks or drives uncomfortable, but by the latter part of 2017 I thought I was doing a bit better and perhaps this was a sign of very slight improvement. I tightened my diet slightly at the start of 2018, but I am so dismayed that the foot pain has got steadily worse, particularly over the last few months. I’ve tried r-alpha lipoic supplements without success and B12 levels are ok following blood test. Various GPs have tried me on Amitriptyline, duloxetine and pregabalin, but none control the pain and the side affects are an issue.

I’m wondering if anyone has experienced anything similar to this? In the last few weeks my feet, toes in particular, have got redder and the skin drier. Of course all this is consistent with advancing peripheral neuropathy but, having been told by GPS that halting or slowing its progress was a real prospect, I’m now despondent. With such discomfort and greatly reduced mobility, and living on my own, it’s difficult to be optimistic.

kitedoc said:

Hi @PaulWright, have you had the circulation to your feet checked as well??

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I’ve only ever seen GPs who have felt areas of my feet, and have been satisfied that circulation is ok. I have not gone further by seeing a consultant or undergoing hospital tests, as local GPs haven’t thought it appropriate. I’m now thinking that I must press them for further investigation, given the reddening of my feet and constant discomfort/pain. I can’t see me being able to function day to day if my condition carries on declining.

Jim Lahey said:

Broadly similar experience here. Increasing neuropathy pain when living with massively lower glucose concentration after spending years chronically elevated pre-diagnosis. For me, only going fully-hardcore ketogenic reversed the damage, and a year later my feet feel incredible and permanently pain-free

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Thanks Jim for your upbeat comments. I had assumed that my LCHF diet was working well, given the rapid loss of so much weight and BS readings that have improved still further over the last year. My carb intake is now very low and I eat plenty of vegetables, eggs, cheese, cream in decaf coffee, and unprocessed meats, smoked salmon etc. I also regularly self-test my BS levels so as to avoid any foods that might spike my readings. Having lost about 40lbs, there is little scope to lose any more without being too skinny. Despite all this, I wonder if my nerve damage is too deep rooted to reverse. If it wasn’t for the reddening of my toes and slight mottling in skin on both feet, I’d be wondering if nerve regeneration was a possibility.

I’ve booked a GP appointment for this evening, and will update the forum with the outcome.

Alison54321 said:

Hello Paul, sorry to hear about your foot pain. As @Jim Lahey says, if you've had an undiagnosed high blood sugarsfor a number of years, then, ironically, good glucose control can, for a while, make the symptoms worse. But a lot of people have said that complications do improve, with better control.

Just keep on doing what you're doing, you're doing a great job.

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Thanks Alison, I greatly appreciate your words of encouragement. This situation has unfortunately stressed me out and no doubt made me feel still worse. When I’ve tried so hard and now face an unforeseen setback, it’s so difficult to believe that better times may lie ahead.

Well I saw another GP this evening who, having checked over my feet, said he didn’t know what was causing the reddening of the toes and feet. He’s referred me to a dermatologist (just tried to book online but says no appointments available!) and doubted whether peripheral neuropathy was necessarily the cause of the increasing redness and soreness. Clearly not knowing what the cause was, he did a bit of online searching and wondered if it could be Erythomelalgia: a guess I didn’t appreciate when I read that it is very rare and incurable.

So back to the drawing board and await a dermatologist’s opinion. I suppose I was hoping the GP would have known more.

The GP did feel some areas of my feet and was satisfied with the pulses. I felt his knowledge of diabetic neuropathy was rather limited, and he was flanneling as he searched online for ideas. On reflection I think it might be worth asking for a referral letter and copy of my recent blood test results (which were all good), in order to see a specialist privately at the London Diabetic Clinic for a detailed assessment and 2nd opinion. I’ve never smoked.

So disappointing that the GPs I’ve seen seem to have such little knowledge of diabetic complications and the ways in which they can play out over time. I still have a strong suspicion that DPN can cause toes and feet to redden and become slightly blotchy. For all I know this could even be a sign of improvement, though at the moment I’m too despondent to hope for such a good outcome.

Thanks, you’re right about the podiatrist given I haven’t seen one since shortly after my diagnosis 4 years ago. She considered my feet low risk and didn’t want to see me again. Times change, however, and the worry of recent changes mean I really should explore all these options. When walking is so uncomfortable, and you feel so despondent, it’s a struggle to get the motivation to organise the various appointments necessary, but I know I’ve got to do it.

Patrick66 said:

I’m no expert on feet but I just wanted to pop in to say how much I admire you and others who do such a great job in getting their numbers down. I’m 6’4” as well and I’m worried that, if I lose too much weight (I’m about 15st now) I’ll look too thin as I’m very broad shouldered but we will cross that bridge when we come to it.

My feet do get red and dry and I get skin cracking between my toes. My feet hurt but I do have fibromyalgia so, unfortunately, it’s just another body part that does. My Mum, a type 2, suffered very badly with her feet but, much like you, she just ended up with a bunch of tablets that had only a minor effect on the pain.

I really hope something can be done to give you some relief. Sending my best wishes your way!.

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Thanks Patrick for your support and encouragement. I don’t know how you’re doing with your numbers, but I found the LCHF diet worked wonders for rapidly reducing weight and BS levels, and I never felt particularly hungry as I adapted to my new diet. The main issue was (and always will be), missing all those foods that I enjoyed so much. I’m now very comfortable with my body weight, which is an ideal BMI if you believe the health ‘experts’, and is actually back to what I was in my early 20’s. The issue I never appreciated was the hidden visceral fat around internal organs that can be so damaging for the healthy working of your pancreas and liver etc. The health benefits of achieving an optimum weight for your height are critical for achieving and maintaining non-diabetic numbers, and you may find that if your weight loss is around your middle then you will be both healthier and look better. One minor downside, however, is needing to buy new trousers!

Your experience with your feet is interesting and just reinforces how vulnerable we are to suffering in this part of the body. I’m seeing a podiatrist next week and will be having full assessment and Doppler scan etc. I’m determined not to be beaten by this problem, which I reckon is the legacy of the years of high BS numbers before I was diagnosed as Type 2 diabetic. I can manage without painkillers, though at the moment I take 20mg of Amitriptyline at night to ensure a decent nights sleep. Although my GP has referred me to a dermatologist for my reddened and dried toes, their heightened sensitivity still suggests to me it is diabetes related.

As others have said, managing diabetes is a marathon rather than a sprint and it certainly requires dedication! Getting despondent at times is perhaps just inevitable, but you can get past those low points. Best wishes and a happy New Year.

LittleGreyCat said:

@PaulWright I have some similarities.

After losing weight (down from 13 stone 5 pounds to 12 stone) I lost quite a bit of body fat. Unfortunately it didn't come off my middle as much as elsewhere. Since then I have suffered intermittent joint pain in parts of my feet, mainly the left foot.

I too have feet which seem fine (by feeling the pulses and the pricker test) with slightly numb areas in the hard skin on the outsides of my big toes.

I did wonder if I had lost some cushioning in my feet due to loss of fat. It may be coincidence, but the foot problems seemed to coincide with the weight loss. This is weird because if you have foot problems it is usually put down to too much weight and you are advised to lose weight.

I suffer from dry skin from time to time but I have put this down to biological washing powder. Moisturising cream helps a lot. there is also a thing called winter dermatitis/eczema which is due to the dryer weather (cold air holds less moisture) combined with central heating which dries out the air inside. Whatever the reason, when I find myself having to scratch my legs and especially the tops of my feet I find a moisturiser normally makes this go away.

Thankfully I only get the occasional problems so I can walk much of the time. Not stopped me driving so far, but I have an automatic car and my left leg/foot seems to be the one which gets the problems.

Best of luck. Hope you find a solution.

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I, too, drive an automatic but still find it uncomfortable as both my feet are sore and so sensitive. I do use moisturiser on parts of my feet and body as your skin tends to get drier as you get older. Likewise, apparently it’s normal to have a reduced pad of fat underneath your feet as you age, and no doubt this, plus substantial weight loss, just makes foot discomfort more of an issue.

Thanks for your encouragement and I will keep plugging away at finding an eventual solution to easing my foot pain.