From the Research
Yes, neuropathy of the heels can occur in diabetes even with an HbA1c of 6.6%, which is considered well-controlled diabetes. Diabetic peripheral neuropathy can develop regardless of glycemic control, though the risk increases with higher blood sugar levels and longer duration of diabetes. The 6.6% HbA1c, while within target range (generally below 7%), doesn't completely eliminate the risk of developing neuropathic complications. Neuropathy develops due to multiple mechanisms including oxidative stress, inflammation, and microvascular damage that can occur even with modest elevations in blood glucose over time.
Key Points to Consider
- The most recent and highest quality study, 1, suggests that diabetic peripheral neuropathy occurs in up to 50% of patients with diabetes mellitus and increases the risk of diabetic foot ulcers and infections.
- According to 1, first-line drug therapy for painful diabetic peripheral neuropathy includes duloxetine, gabapentin, amitriptyline, and pregabalin.
- For patients experiencing heel neuropathy symptoms (burning, tingling, numbness, or pain), management typically includes:
- Maintaining good glycemic control
- Regular foot examinations
- Proper footwear
- Medications like gabapentin (300-1200mg daily), pregabalin (75-300mg daily), or duloxetine (30-60mg daily) for symptom relief
- Physical therapy and topical treatments such as capsaicin cream may also help
- It's essential to have regular neurological examinations by healthcare providers to monitor progression and adjust treatment as needed, as stated in 2.
- Additionally, 3 highlights the importance of being aware of treatment-induced neuropathy of diabetes (TIND), which can occur with rapid improvement in glycemic control.