What Is Peripheral Neuropathy?

Peripheral neuropathy is the damage of peripheral nerves, or the nerves leading to your fingers and toes.  For podiatry purposes, it effects the nerves leading to your toes.  The nerves affected can be both sensory nerves (responsible for feeling) and motor nerves (responsible for muscle movement.) When nerves are damaged, they do not function adequately causing abnormal feelings in your extremities.  In fact, in the feet and toes, the feeling can manifest itself in abnormal sensations ranging from burning, itching, and pain to numbness and lack of feeling.  Since nerves also affect your muscles, peripheral neuropathy can also affect the movement and balance in your legs, or lower extremity, as well.

How Is It Diagnosed?

Often this condition is diagnosed by a specialist, sometimes by your primary care doctor or your podiatrist after a thorough exam, with emphasis given to your symptoms.  Your doctor may order blood tests to determine if you have diabetes and its severity, a common cause of peripheral neuropathy. If there is a particular area on your legs or feet that are worse than the other, your doctor may order nerve conduction velocity tests or other nerve-specific tests that will determine if your nerves are causing your symptoms.  Often, these tests are sensitive enough that the test may determine which nerves and even focus on the severity of each nerve.  Your podiatrist may also recommend an in-office nerve biopsy, called an epidermal nerve fiber density test, that will detect any neuropathy in your feet and legs and also determine its severity.  This is measurable and can be repeated in 6 to 12 months to monitor if the neuropathy is worsening.

What Are The Causes Of Peripheral Neuropathy?

According to the ADA (the American Diabetes Association), over 60% of people with diabetes will experience some sort of symptoms from neuropathy.  Other cause of neuropathy include:

Heredity – If someone in your family had neuropathy, you may have a genetic predisposition to also have it. 

Alcoholisim – The exact cause of Alcoholic Neuropathy is unknown.  It is thought to be caused by alcohol itself damaging the nerves, along with poor nutrition and lack of essential vitamins and minerals that often accompanies alcoholism. 

Advanced Age – Peripheral neuropathy happens to be more common in the elderly population

Certain Medications – Most commonly, some chemotherapy drugs cause peripheral neuropathy as a side effect.  Sometimes it is temporary, other times the side effect is permanent.

Neurological Disorders – Certain neurological disorders including spina bifida, multiple sclerosis, and fibromyalgia may have a concurrent effect of peripheral neuropathy.

Thiamine Deficiency – There have been studies that have shown that patients with decreased thiamine suffer from symmetrical (same on both sides) peripheral neuropathy of the feet and legs. 

Injury – Acute injury after trauma may cause neuropathy. Sometimes spinal injury can affect nerves leading to the extremities causing similar symptoms.

Chronic Conditions – Some chronic back/spine conditions may cause peripheral neuropathy in the feet and legs, or sometimes in the hands and fingers as well.  Advanced testing modalities such as an MRI or other imaging of the spine may confirm the biomechanical cause stemming from the spine.

What Are The Symptoms Of Peripheral Neuropathy?

The most common symptoms a podiatrist will see is numbness in the toes.  Often this is accompanied by tingling, a pins and needles feeling, or even pain. Patients describe that their socks are “bunched up” in their shoes, but they look at their socks and they are completely fine.  Others describe that they are “walking in sand” and unable to feel their toes, although they are able to wiggle their toes and move their feet. Some patients state that their feet feel completely ice cold all the time, however you touch their feet and they are as warm as their hands.  Some patients feel a tingling feeling like “ants crawling up and down” their feet and legs.  Others only feel any sort of discomfort only at night, when their feet are up or they are in bed.

What Are My Treatment Options?

Although there is no definitive known cure for neuropathy, our goals of treatment are simple – to slow the progression of the disease, to maintain foot health, and to decrease pain and discomfort to improve your quality of life.  Your podiatrist will show you how to conduct a home exam on your feet and lower extremities that can be performed daily.  If you have been diagnosed with peripheral neuropathy, you should be seen by your podiatrist at regular intervals.  Prevention is key! If you have diabetes, work closely with your primary care doctor or endocrinologist and your local diabetes center at the closest hospital.  Most diabetes centers have a comprehensive team that consists of diabetic educators, dieticians, and nurses to help control your blood glucose levels that will in turn decrease the severity of your symptoms.  For pain control, your primary care doctor or your neurologist may prescribe oral medications.  Some offices recommend supplements, considered medical foods, containing benfotiamine, an antioxidant and thiamine (vitamin B1) analogue.  There has been research to show that these types of supplements can decrease the symptoms of peripheral neuropathy.


Are There Any Topical Medications That Would Help?

Our practice works with a local compounding pharmacy that has several different formulations that are helpful in reducing symptoms of neuropathy.  The medication must be applied 3-4 times a day, but many patients have found relief with the topical applications. This is a viable alternative for patients that want some relief, but they are reluctant to take oral medications due to the side effects. 

What Else Can I Do?

Peripheral neuropathy affects sensory nerves, causing the painful/tingling/burning/numbness and pain as described above. However it can also effect motor nerves, causing balance issues, or the feeling of being “unsteady on your feet.” For balance issues, we may recommend physical therapy for balance and proprioception training.  In addition, we may recommend a brace, worn on both ankles, to help improve balance and decrease the risk of falling due to imbalance.  This type of brace, called a Moore Balance Brace, is a simple brace that contains a customized arch support, footplate, and adjustable straps.  It fits into regular shoes and is light weight and easy to put on and remove. 

What’s My First Step?

The first step to take if you have symptoms listed above and you think you might have peripheral neuropathy in your feet or lower extremities is to make an appointment with one of our physicians and Prairie Path Foot and Ankle Clinic.  We will perform a thorough lower extremity exam. We will come up with a treatment plan and work closely with your primary care physician or neurologist.