Diabetes Self-Management Articles

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Improving Blood Flow to the Feet
The Power of Relaxation and Biofeedback

by Birgitta I. Rice, MS, RPh, CHES

Many people with diabetes experience discomfort in their legs and feet, with symptoms such as cramping, numbness, tingling, and pain. The culprits may be poor circulation, nerve damage, or both, and the underlying causes are referred to as peripheral arterial disease (PAD) and peripheral neuropathy. While both appear to be triggered by high blood glucose levels and some of their symptoms overlap, they are two distinct conditions.

In the most common form of PAD, arteries in the legs (and sometimes arms) narrow and harden as a result of fatty plaque deposits, leading to decreased blood flow in the legs and feet. This disorder affects 8–12 million Americans and is far more common in people with diabetes than in the rest of the population: About one-third of people with diabetes over the age of 50 have PAD, although many of them are undiagnosed. Symptoms of PAD include intermittent claudication (cramping leg pain that develops while walking and stops with rest); numbness, coldness, or tingling of the legs and feet; and slow healing of cuts and sores on the affected extremities.

Diabetic peripheral neuropathy is a common complication of diabetes in which nerves in the feet and legs (and sometimes hands and arms) are damaged, resulting in pain and/or loss of sensation. While the exact mechanism by which neuropathy develops is not known, the condition usually develops after years of exposure to high blood glucose levels. Weakened nerve fibers may give off false sensations in the extremities, often experienced as pain or burning; cramps and extreme sensitivity to touch may also result. The loss of nerve fibers can result in muscle weakness, numbness, loss of reflexes, foot deformities, change in gait, and impaired balance and coordination. Loss of sensitivity to pain or temperature can also occur, leading in turn to blisters and sores from foot injuries that go unfelt. If circulation is poor (as a result of PAD, for instance), such wounds may be slow to heal, leading to foot ulcers. Eventually, gangrene may result and amputations may be necessary.

Treatments
Many treatments are available to relieve the pain and discomfort of PAD and neuropathy. Drug treatment is often the first one offered. For PAD, pain relievers, blood thinners, and other drugs that improve blood flow may be prescribed. Drugs prescribed for peripheral neuropathy include pain relievers, certain antidepressants and anticonvulsants, and, as a last resort, narcotics. However, many medicines have side effects and may not be tolerated. For neuropathy, there are also ointments for topical use and therapies such as transcutaneous electrical nerve stimulation (TENS), which uses electricity to block pain signals, and monochromatic infrared energy therapy, which uses near-infrared energy to increase blood flow and relieve pain. Vascular surgeries such as angioplasty or bypass may be used to treat severe PAD, and surgery to relieve nerve compression can help certain types of neuropathy.

If the immediate problem is limited blood flow, a simple and inexpensive complementary therapy is a guided relaxation and biofeedback method called WarmFeet. This trademarked mind–body technique can increase blood flow to the periphery of the body and relieve pain. Regular practice of the WarmFeet technique also provides side benefits such as lower blood pressure and improved coping skills, both quite useful for people with diabetes.

How relaxation helps
Have you ever wondered why putting your feet up and relaxing after a long day feels so good? There is a physiological explanation. The body’s reactions to stress and relaxation fall at opposite extremes on the continuum of nervous system activity. The nervous system generally maintains a balance between its sympathetic (action oriented) division and its parasympathetic (rest and recovery) division. Stress provokes the “fight or flight” response of the sympathetic division, which increases heart rate, blood pressure, and blood glucose levels and increases blood flow to the brain, heart, and skeletal muscles. These effects are often prolonged by the release of stress hormones. Relaxation, on the other hand, provokes an increase in parasympathetic activity, which reduces heart rate and blood pressure and routes blood away from the muscles and vital organs and toward the digestive system and the skin. This increased blood flow to the skin warms it and increases the amount of oxygen and nutrients available to the periphery of the body.

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