Peripheral Neuropathy: Signs, Causes, Treatment & Foot Care
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Introduction
Peripheral neuropathy means nerve damage outside the brain and spinal cord 1,4. This guide covers its symptoms, causes, treatment, and foot care.
Peripheral nerves carry messages between the central nervous system and the body 1,4. The central nervous system includes the brain and spinal cord 1.
Neuropathy may affect feeling, movement, or automatic body functions 1. Symptoms depend on which nerves are damaged 4.
Foot care needs close attention when feeling is reduced. Numbness may let pressure, blisters, and sores go unnoticed 3. Diabetes can make these wounds harder to heal 3.
Early medical care may help control symptoms and limit more nerve damage 6. Treatment depends on the cause, symptoms, and affected nerves 4.
Overview: What Is Peripheral Neuropathy?
How peripheral nerve damage affects the body
Peripheral nerves link the brain and spinal cord with muscles, skin, and organs 1,4. Damage can block signals or make nerves send the wrong messages 5.
More than 100 types of peripheral neuropathy have been found 1,4. Some affect one nerve, while others affect many nerves 5,6.
Mononeuropathy is damage to one nerve 6. Polyneuropathy affects many nerves across the body 6.
Different types can develop at different speeds 1,4. Symptoms may appear within days or develop over months or years 1,4.
Sensory, motor, and autonomic neuropathy
Doctors often group neuropathy by the type of nerve involved. Some people have damage in more than one nerve group 8.
The three main groups have separate roles:
Sensory nerves detect pain, touch, heat, cold, vibration, and body position 5,6.
Motor nerves control muscles used for planned movement 1,5.
Autonomic nerves control tasks that happen without conscious thought 1,4.
These automatic tasks include blood pressure, digestion, sweating, and urination 5,6.
A mixed neuropathy can involve two or three nerve groups 8. Its symptoms may affect both feeling and movement 8.
Why symptoms often begin in the feet
Most neuropathies are length-dependent 1. This means the longest nerves are affected first or most severely 1.
The longest nerve endings reach the feet 1. Therefore, symptoms often begin or feel worse in the feet 1.
Symptoms may then spread upward into the legs 1,6. They may later affect the hands or arms 6.
Some types do not follow this pattern 1. Their symptoms may affect the torso or move between body areas 1.
Symptoms and Warning Signs
Peripheral neuropathy symptoms may be mild or severe 1,4. They can affect the feet, legs, hands, or arms 3.
Sensory symptoms in the feet and hands
Sensory nerve damage changes how the body detects touch, pain, and temperature 4,5. If sensory nerves are affected, possible symptoms include:
Numbness or reduced feeling in the hands or feet 4,6.
Tingling that feels like pins and needles 3,5.
Burning, stabbing, sharp, or electric-shock pain 5,6.
Reduced awareness of heat, cold, pain, or an injury 1,4.
Pain caused by light touch, clothing, or bedsheets 1,6.
A false feeling of wearing gloves or socks 6.
Less ability to detect vibration or touch 1,3.
Allodynia means pain caused by touch that would not normally hurt 1. For example, bedsheets may cause severe pain against the skin 1.
Nerve pain may become worse at night 1,3. It can disturb sleep and daily life 1,8.
Loss of feeling creates a different risk. Pressure or injuries may cause blisters and sores without being noticed 3.
Motor symptoms
Motor nerves control muscle movement 1,5. If motor nerves are damaged, possible symptoms include:
Muscle weakness in the hands, feet, arms, or legs 4,8.
Muscle twitching that may be seen beneath the skin 1.
Loss of muscle tissue, called muscle atrophy 1,5.
Problems with balance, walking, or coordination 3,6.
Changes in the usual walking pattern 3.
Loss of movement with severe motor nerve damage 6.
Balance problems can increase the risk of falling 3. Falls can result in broken bones and other injuries 3.
Autonomic symptoms
Autonomic nerves manage body tasks that happen without thought 1,4. If these nerves are affected, symptoms may include:
Blood pressure changes that cause dizziness or lightheadedness 6.
Sweating too much or too little 4,5.
Trouble coping with heat 1,6.
Nausea, vomiting, bloating, diarrhea, or constipation 4,5.
Trouble with urination or bladder control 4,8.
Changes in sexual function 1,4.
A heartbeat that is too fast, slow, or irregular 4,5.
These symptoms can differ between people. The exact pattern depends on which nerves are involved 4.
Warning signs that need medical care
New nerve symptoms should not be ignored. Early diagnosis offers the best chance to manage symptoms 6.
If tingling, weakness, or pain affects your hands or feet, seek medical care right away 6. If you have diabetes, report any foot problem to your clinician right away 3.
Causes and Risk Factors
Peripheral neuropathy has many possible causes 4,6. It may result from an illness, injury, medicine, toxin, or inherited condition 4,6.
Diabetes and other health conditions
Diabetes is the leading cause of peripheral neuropathy in the United States 1. Up to one-half of people with diabetes have peripheral neuropathy 3.
Over time, high blood glucose can harm nerves 3. It can also damage the small blood vessels that feed those nerves 3.
Other health conditions linked with neuropathy include:
Long-term kidney or liver disease 4,5.
An underactive thyroid, also called hypothyroidism 6.
Metabolic syndrome and related problems 6,7.
Low vitamin B12 or other vitamin imbalances 4,5.
Some blood and bone marrow disorders 5,6.
Blood vessel problems that reduce blood flow 4,7.
Medicines, alcohol, toxins, and low vitamin levels
Chemotherapy can damage peripheral nerves 1,5. Radiation therapy and some other medicines may also cause nerve disorders 4.
Certain antibiotics have also been linked with neuropathy 5. A medical review should include current and past medicines 9,10.
Alcohol use disorder may directly damage nerves 5. It may also contribute to poor food intake and low vitamin levels 5,6.
Other possible causes include the following exposures or deficiencies:
Heavy metals, including lead and mercury 4,6.
Industrial chemicals and other harmful substances 5,6.
Low levels of copper or certain vitamins 5.
Long exposure to cold conditions 7.
Immune, infectious, inherited, and physical causes
Autoimmune disease makes the immune system attack healthy tissue. Lupus, rheumatoid arthritis, and vasculitis may damage nerves 5,6.
Guillain-Barré syndrome involves an immune attack against the nerves 1,6. Another immune disorder is chronic inflammatory demyelinating polyneuropathy 1,6.
Several infections may lead to neuropathy, including:
Leprosy, also called Hansen’s disease 5,6.
Inherited disorders may also damage peripheral nerves 4,6. Charcot-Marie-Tooth disease is one inherited form 4,6.
Tumors may grow on a nerve or press against it 5,6. Injuries may stretch, crush, cut, or place pressure on nerves 4.
A herniated disc or swelling may pinch a nerve 5. Casts, braces, crutches, or carpal tunnel syndrome may also place pressure on nerves 7.
Sometimes testing does not find a clear cause 1,5. Doctors call this idiopathic neuropathy 1,5.
Diagnosis and Treatment
Medical history and nerve examination
Diagnosis starts with a review of symptoms and health history 3,10. Your clinician may also ask about your family health history 4,10.
Other questions may cover alcohol use, medicines, lifestyle, and toxin exposure 10. These details may point toward a possible cause 10.
A neurological exam may assess these areas:
Muscle strength and muscle tone 10.
Touch, vibration, and temperature awareness 3,10.
Balance and coordination 3,10.
Walking patterns, also called gait 3.
Blood flow and general foot health 3.
Blood tests and nerve tests
Blood tests can check for diabetes or low vitamin levels 10. They may also find signs of inflammation or metabolic problems 10.
Other blood tests may check thyroid, kidney, or liver function 3,7. The results may reveal a condition linked with nerve damage 3,7.
Your care team may use these added tests:
Nerve conduction studies measure how nerves respond to a mild electric current 10.
Electromyography records electrical activity inside the muscles 10.
CT or MRI scans can show growths or compressed nerves 4,10.
Autonomic tests measure sweating and other automatic nerve functions 4,10.
Genetic tests may help find inherited nerve disorders 4,9.
A biopsy removes a small sample of nerve, skin, or other tissue 4,10.
Treating the cause
Treatment first focuses on the condition causing the nerve damage 4,10. Treating that condition may allow some nerves to improve over time 4.
Diabetes care includes control of blood glucose, blood pressure, and cholesterol 3. Staying near personal targets may help stop nerve damage from getting worse 3.
Tests may find a low vitamin B12 level 3. A clinician may then give B12 supplements after finding the cause 3.
Metformin can sometimes contribute to a low B12 level 3. The medicine may continue while the deficiency receives treatment 3.
Managing another illness or adjusting medicines may make a meaningful difference 9. Medicine changes should be part of a clinician-led treatment plan 9.
Surgery may relieve pressure from a tumor or another structure 4,10. It may also repair some injuries that cause nerve pain 8.
Pain control
Pain treatment does not change the existing nerve damage 3. It aims to reduce discomfort and improve daily function 3,9.
Clinician-guided choices may include:
Topical lidocaine creams or patches placed on painful skin 10.
Certain antiseizure medicines, such as gabapentin or pregabalin 10.
Certain antidepressants that affect how pain signals are processed 10.
Electrical stimulation or other non-drug pain methods 4,9.
All medicines can cause side effects 3. Antiseizure medicines may cause dizziness or sleepiness 10.
Some antidepressants may cause nausea, dry mouth, dizziness, or constipation 10. Ask your clinician about possible side effects before treatment 3.
Common nonprescription pain medicines may not work well for nerve pain 3. They can also cause side effects 3.
Rehabilitation and specialized care
Physical therapy can help with weakness, balance, or movement problems 10. Occupational therapy can make daily tasks safer and easier 9.
Rehabilitation may include these tools and services:
Balance training to support safer movement 9.
Neuromuscular training to help with strength and movement 9.
Braces or splints for weak hands or feet 4,10.
Orthotics, which are supports placed inside shoes 8,9.
Canes, walkers, or wheelchairs for added support 10.
Some immune-related neuropathies need special treatment 10. Options include steroids, plasma exchange, or intravenous immune globulin 10.
These treatments target inflammation or immune attacks 10. They are not used for pain alone 10.
Foot Care for Peripheral Neuropathy
Why foot checks matter
Numbness may hide pressure, injuries, blisters, and sores 3. A person may keep walking without noticing the problem 3.
Diabetes can make foot wounds difficult to heal 3. Poor healing raises the chance of infection 3.
Severe sores and infections can lead to loss of a toe or foot 3. They may also lead to loss of part of the leg 3.
Daily checks for people with diabetes
If you have diabetes, check your feet every day 3. Look over both feet for these problems:
A new blister or open sore 3.
Swelling in one or both feet 3.
A change in the shape of a foot or toe 3.
Any other new foot concern 3.
Do not leave a foot injury untreated 8. Report any foot problem to your clinician right away 3.
Finding and treating foot problems early lowers the chance of serious infection 3. A podiatrist can provide expert care for foot problems 3.
For nail concerns, read our guide to [ingrown toenail care](/conditions/ingrown-toenail-symptoms-treatment-prevention-054385).
Foot exams for people with diabetes
People with diabetes need a full foot and sensation exam each year 3. Exams may be needed more often when foot problems are present 3.
A clinician may check foot blood flow, sensation, and walking patterns 3. The exam may also assess balance and skin condition 3.
Common sensation tests include the following methods:
A tuning fork checks whether you feel vibration in the toes and feet 3.
A nylon strand checks whether you can feel light pressure 3.
Temperature testing checks whether you can detect hot and cold changes 3.
The nylon strand test is called a monofilament test 3. Remove your shoes and socks in the exam room 3. This can remind your clinician to examine your feet 3.
Foot-shape changes and falls
Charcot foot is a rare problem in some people with diabetes 3. It damages bones and other foot tissue 3.
This damage can change the shape of the foot 3. Report new swelling or shape changes to your clinician right away 3.
Neuropathy may also affect balance and raise the risk of falls 3. Falls can result in fractures or other injuries 3.
Physical therapy may help when balance or weakness affects movement 10. Braces, orthotics, or walking aids may offer added support [8-10].
When to See a Doctor
Seek medical care right away for new tingling, weakness, or pain 6. This advice applies when symptoms affect your hands or feet 6.
If you have diabetes, call your clinician about any new foot problem 3. Examples include a blister, sore, swelling, or foot-shape change 3.
Tell your clinician about changes in walking or balance 3. Also report repeated falls 3. Rehabilitation or an assistive device may help with these problems 9,10.
Regular follow-up is also important for people with diabetes 3. A full foot and sensation exam is advised at least yearly 3.
Conclusion
Recognizing nerve symptoms early may help limit more nerve damage 6. Testing can also find causes that need direct treatment 4,10.
A care plan may address the cause, pain, strength, and balance 9,10. Treatment choices should reflect your symptoms and other health needs 3,4.
Careful foot checks are especially important for people with diabetes 3. Prompt care for foot problems can lower the risk of serious infection 3.
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