Dear Mrs. Smith,
Thank you so much for writing us to inquire about the Epidermal Nerve Fiber Density test that your podiatrist has recommended to you based on your recent diagnosis of diabetes, and complaints of aches and pains in your feet.
First, let us assure you that your doctor was absolutely right in saying that a diagnosis of diabetes does not mean a compromise in quality of life for you. In fact, you are in the company of many well known persons who lead active and productive lifestyles and are diabetic; Halle Berry, Larry King, Dick Clark, and Elizabeth Taylor are a few names that might sound familiar!
Being diabetic, however, does mean that you should be more aware of certain symptoms you might experience, and you should maintain an open line of communication with your podiatric clinician regarding such symptoms so that their significance and potential treatments may be assessed. One way to investigate the significance of the tingling and burning that you described during your recent visit to the foot care specialist is through a simple test which allows for an objective diagnosis of small fiber peripheral neuropathy, called epidermal nerve fiber density analysis. Small fiber peripheral neuropathy can be the cause of your pain and discomfort, but more importantly, it can eventually lead to total loss of sensation (numbness) in the feet. This is especially important information for diabetic persons, since a lack of sensation will often cause affected individuals to develop an ulcer, or overlook a wound, which if left untreated, can lead to more severe situations followed by loss of limb.
Mrs. Smith, we at Bako Podiatric Pathology Services are proud to be one of very few labs that offer a test that will help your podiatrist diagnose small fiber peripheral neuropathy (epidermal nerve fiber analysis). In fact, this test can also predict neuropathy before the onset of clinical symptoms. This can allow podiatrists to implement a proactive treatment regimen that can potentially delay or eliminate the onset of neuropathy in the future. In your case, such therapy will often help curb your existing symptoms and prevent them from getting worse. Also important to remember, this quantitative and qualitative test will rule out neuropathy if none is present, so your doctor can focus on determining the true etiology of your discomfort.
The Epidermal Nerve Fiber Density analysis requires a small 3mm punch of skin performed approximately 10cm proximal to the lateral malleolus (right above the ankle), as there are established normative ranges at this site. The specimen is then placed in special fixative (Zamboni's) for 8-24 hours, and then sent to our lab for analysis. Your podiatrist should receive the results in about a week. The whole process should not take more than a couple of minutes since the kit that we provide comes with the items that are essential to performing the biopsy (such as the punch, scissors, forceps, iodine, alcohol, gauze, and bandage), with the exception of the local anesthetic. The biopsy site should not require any stitches because of the small and shallow nature of the punch. Just remember to keep the biopsy site dry for 1-2 days and then resume showers with daily bandage changes. The wound should close completely in just a few of days. We provide a CD with suggestions regarding the biopsy procedure and tissue handling for your podiatrist to view prior to your appointment so that he/she will be absolutely confident in the process.
If it is determined that you do have small fiber peripheral neuropathy, or there are changes that suggest the future development of this disorder, your many therapeutic options will be discussed with you by your doctor. One oral medication may even help to regenerate small peripheral nerve fibers and dramatically reduced you symptoms. This is potentially a way to "stop neuropathy in its tracks", especially when the diagnosis is made early. Your podiatrist will likely want to repeat the test six months into the treatment so see if the regimen they have suggested is working, and to give you peace of mind by letting you see the proof yourself!
Last but not least, our test kits have a three month expiration date, so your physician should already have one on-hand when you make your appointment.
Please do not hesitate to call or write if you have further questions. We are here to help!
Magdalena Rosol, Account Manager-Michigan
and all your friends at Bako Podiatric Pathology Services
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