Top 4 tools to prevent and manage chemotherapy induced peripheral neuropathies of the feet
Rehab Tools for Chemotherapy Induced Peripheral Neuropathies of the Feet
Neuropathies are very common within the cancer population. They can be a result of radiation, surgery, or chemotherapy. Most commonly, they are caused by chemotherapy induced damage to sensory nerves. They're experienced as tingling or pain in the hands and feet; known as chemotherapy induced peripheral neuropathies (CIPN).
As this blog is in partnership with SOLE, we will explain CIPN in general but focus primarily on the occurrence within the feet. We will explore how chemotherapy induced peripheral neuropathies (CIPN) occur, how to diagnose them and better yet tools to manage them!
Akin to my previous blog on managing hormone therapy within breast cancer, I will focus on science backed tools that are low risk such as managing foot health and using cold exposure.
Chemotherapy Induced Peripheral Neuropathies Explained
Our central nervous system includes our brain and spinal cord. The central system is less exposed to toxins as compared to the peripheral system. All of the components outside the brain and spinal cord are termed ‘peripheral’ and are more vulnerable to the effects of chemotherapy.
The peripheral system includes your autonomic nervous system, working in the background with little conscious thought. Peripheral nerves can get jangly, impacting gaze, bowel health, or sensation. Most commonly however, patients experience the symptom of tingling or pain in the hands and/or feet.
If you are concerned about your nerve symptoms, a neuropathy assessment offered here at the cancer physio may provide some answers.
Types of Chemotherapy
Taxanes
Plantinums
Vinca Alkaloids
Targeted Therapies
Main Symptoms of Chemotherapy Induced Peripheral Neuropathies:
Bilateral altered sensations of pain (numbness or hypersensitivity)
Bilateral altered perceptions of temperature, vibration, or touch
Bilateral electrical, burning or shooting sensations
Bilateral numbness, tingling, or itchiness
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Weakness and/or shakiness
Muscle wasting and/or cramping
Difficulty walking
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Altered sensations of pain (numbness or hypersensitivity)
Trunk or hip pain ~3 days post chemotherapy injection
Altered perceptions of temperature, vibration, or touch
Electrical, burning or shooting sensations
Numbness, tingling, or itchiness
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Constipation or diarrhea
Bladder incontinence
Dizziness
Blood pressure changes
Why do Chemotherapy Induced Peripheral Neuropathies occur?
While chemotherapy has saved many lives, it is classified as cytotoxic and at times cardio-toxic. Chemotherapy can cause injury to the peripheral nerves due to a change in intracellular transport in those nerves. In these instances, the transportation of information down the nerve’s core is disrupted, leading to alterations at the very end.
Imagine a tree with healthy roots but with yellowing leaves. The leaves are the last part of the branching system where leftover nutrients finally get to. When it comes to neuropathies of the feet, you can think of your feet in the same way as those leaves: the furthest point that disrupted nerves must send and receive information, and thus the most likely to be disrupted.
How to Prevent and Manage CIPN in the Feet.
#1) SPEAK UP.
Dose Delay May be an Option, if Tingling Symptoms are Worsening.
Patients who have had other neuropathies prior to their diagnosis or have a family history of neuropathies may be at increased risk. Additional risk factors are age, obesity, diabetes, and previous lymph node removal. Discuss your health history with your oncologist to understand your risk level for CIPN.
If you have pre-existing neuropathies consider a neuropathy assessment to track any concerns moving forward with treatment.
Those with cancer are often in survival mode; pushing symptoms to the wayside to prioritize treatment. In the case of neuropathies, the changes can be permanent, impacting your long term quality of life.
If nerve symptoms are occurring, speak to your oncologist right away. There are options. You can discuss medications that are less known to cause CIPN or your oncologist may consider a chemotherapy dose delay.
#2) FOOT HEALTH.
Maintaining blood flow and general foot health reduces the risk of CIPN. Managing the load placed on the plantar fascia, pressure on nail beds and general circulation to the feet is vital in maintaining tissue health. Exercise, in addition to supportive footwear can help maintain circulation to the feet.
I have mentioned the benefits of exercise in cancer in previous blogs. Following the SAFE exercise guidelines can allow you to exercise confidently in any stage of treatment, especially when undergoing chemotherapy.
Good footwear should include an orthopedic insole. SOLE’s insole design prioritizes plantar fascia support through arch support, optimal joint loading through metatarsal padding and foot stability through a deep heel cup. SOLE footbeds can easily be moved from shoe to shoe. Their Thick options offer thick cushioning as well as essential structural support. Their Thin options are extremely versatile in that they fit into any shoe. SOLE Medium footbeds options offer the best of both worlds: a medium layer of cushioning that still fits most regular-fitting footwear like running shoes.
*I have no profit affiliation with SOLE, but I am proud to offer free shipping and discounts to the cancer physio patients
#3) SAFETY
Prevent accidental burns by using oven mitts when handling hot plates.
Check the temperature of your hot water tank at home, keep it less than 40 degrees Celsius.
If you feeling unsteady or tripping on your feet, consider a mobility assessment through a cancer physiotherapist; the prescription of a walker or cane may be helpful.
If needed consider using handrails on the stairs, grab bars in the shower, mats in the tub and assure there isn’t tripping hazards such as loose rugs or clutter around your home
If you can’t feel the gas pedal and brake pressure through your shoe, consider a cancer physiotherapy assessment to assess if you’re safe to drive
When doing dishes, wear rubber gloves as it provides a better grip and protects your hands from cuts
Keep your house well-lit inside and out.
Try Safe Cold Exposure to Prevent and Manage CIPN
#4) COLD PLUNGE
Research has shown that cold exposure can lead to a reduction in neuropathies by as much as 50%(Eckhoff L et al. 2013).
Cold exposure can include a cold bath, cold shower, cold body of water or the use of cryotherapy equipment. I have highlighted our cold plunge protocol in previous blogs, or see the video link above for those who want to learn more and get started safely. Our cold exposure protocol may help to prevent and manage chemotherapy induced peripheral neuropathies of the feet for those undergoing chemotherapy.
The goal is to focus on your breathing rate; aim to slow it down and make your exhales longer.
#4) Rehab Tool: EXERCISE AS MEDICINE...
I have mentioned the benefits of exercise in cancer in previous blogs. Following the SAFE exercise guidelines below can allow you to do so confidently in any stage of treatment, especially when undergoing chemotherapy.
By having a rehab plan personalized to you whether it’s prevention or management, adaptations can occur and rehab tools can work.
Once again I hope this leaves you with some tools and more importantly curiosity. With curiosity comes openness; and with openness comes possibility.
As always, thank you for your interest in science and rehab.
Kindly, The Cancer Physio
References
Beijers AJM, Bonhof CS, Mols F, et al: Multicenter randomized controlled trial to evaluate the efficacy and tolerability of frozen gloves for the prevention of chemotherapy-induced peripheral neuropathy. Ann Oncol 31:131-136, 2020
Chappell, A. G., Bai, J., Yuksel, S., & Ellis, M. F. (2020). Post-Mastectomy Pain Syndrome: Defining Perioperative Etiologies to Guide New Methods of Prevention for Plastic Surgeons. World journal of plastic surgery, 9(3), 247–253. https://doi.org/10.29252/wjps.9.3.247
Courneya KS, McKenzie DC, Mackey JR, et al: Subgroup effects in a randomised trial of different types and doses of exercise during breast cancer chemotherapy. Br J Cancer 111:1718-1725, 2014
Eckhoff L, Knoop AS, Jensen MB, et al: Risk of docetaxel-induced peripheral neuropathy among 1,725 Danish patients with early stage breast cancer. Breast Cancer Res Treat 142:109-118, 2013
Loprinzi, C. L., Lacchetti, C., Bleeker, J., Cavaletti, G., Chauhan, C., Hertz, D. L., . . . Hershman, D. L. (2020). Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: ASCO guideline update. Journal of Clinical Oncology, 38(28), 3325-3348. doi:10.1200/jco.20.01399
Ruddy KJ, Le-Rademacher J, Lacouture ME, et al: Randomized controlled trial of cryotherapy to prevent paclitaxel-induced peripheral neuropathy (RU221511I); an ACCRU trial. Breast 48:89-97, 2019
Zimmer P, Trebing S, Timmers-Trebing U, et al: Eight-week, multimodal exercise counteracts a progress of chemotherapy-induced peripheral neuropathy and improves balance and strength in metastasized colorectal cancer patients: A randomized controlled trial. Support Care Cancer 26:615-624, 2018
