I Have Tingling and Numbness In My Toes – What Could It Be?

If you are feeling tingling and numbness in your toes that has come on gradually, it could be peripheral neuropathy.  Peripheral neuropathy is a condition that affects the small nerves in your fingers and toes.  The nerve endings are affected due to different causes.  The feeling is sometimes described as tingling, numbness, or lack of feeling.  In the toes, patients describe a burning sensation, or a cold/freezing sensation even though they may be wearing socks or it is warm outside.  Nevertheless, these sensations can be a nuisance in the background, or can be so painful or distracting that it may keep you up at night.  What causes peripheral neuropathy in the lower extremity? There are 5 main causes that can affect a patient.

Top 5 causes of neuropathy in your lower extremity:

  1. Diabetes Can Cause Peripheral Neuropathy

Diabetes affects 30.3 million people, or 9.4%, of the population in the United States, according to the American Diabetes Association (ADA).  Some are Type 1, or insulin dependent and likely had this since childhood, and most are Type 2, or non-insulin dependent, and have developed diabetes over time.  Most people talk about the effects of high blood sugars affecting everything from kidney function to energy levels to eyesight; however in the feet, the 2 main things a podiatrist is looking to monitor is blood flow and nerves.  When a patient comes to the office for a visit, the podiatrist will check the patient’s pulses and also perform several simple tests on both feet to determine if the patient has neuropathy.  These very simple tests allow the doctor to also detect if neuropathy has worsened.  The increase in blood glucose levels has an affect on the very tiny, or peripheral, nerves that go to the tips of the toes.  This may cause a lack of feeling, lack of sharp/dull differentiation, lack of vibratory sensation, and lack of protective sensation.  This is very important to determine if the patient has the “gift of pain.” For example, if a patient steps on a foreign object but does not no feel it, this may go unattended and thus cause an infection.  Or, if a patient who cannot feel a blister because shoes are too tight may continue to wear that tight shoe, and the blister in turn can become an infected open wound, leading to complications such as infection and the need for oral antibiotics, IV antibiotics, surgery, or more seriously if there is lack of healing, can even lead to amputation. For this reason, it is recommended that a patient with diabetic neuropathy should have their feet examined at regular intervals to prevent any complications from occurring.  In addition, your podiatrist will teach you how to administer a self-exam in order to prevent neuropathy from causing further damage to the feet or lower extremity. Controlling blood sugars often decrease symptoms.

  1. Alcoholic Neuropathy

Alcoholism itself is a disease, but there are also many side effects of increase intake of alcohol.  The alcohol toxicity takes a toll on the nerves, especially those in the feet and tips of the toes.  The feelings of tingling, numbness, and burning sensations are all consistent with neuropathy.  The tingling sensation may last a few months, or may last a few years.  Decreasing alcohol intake may improve the symptoms, however it is believed that nerve damage due to alcohol toxicity may not be reversed.  There are the same risk factors for the feet, and it is important for a patient to be seen periodically by a podiatrist for a thorough exam. 

  1. Chemotherapy Induced Peripheral Neuropathy

Chemotherapy is a necessary treatment for some cancer conditions, and the list of side effects is numerous.  One of the most common side effects that no one really talks about is chemotherapy induced peripheral neuropathy.  As a cancer patient undergoes chemotherapy, the effects of tingling and numbness may be immediate, or may come later.  This type of neuropathy can also be treated with medication, but for some reason may not respond as well.  For this type of neuropathy, the effects of numbness, tingling, burning, or pin-prick pain may last long after the chemotherapy is finished.  Doctors are not sure why there is such lingering effects long after the chemotherapy is finished. 

  1. Nutritional Cause For Peripheral Neuropathy

Nutrition is such a vital part of our health that lack of certain vitamins and minerals can also cause peripheral neuropathy.  In this case, it is the lack of B vitamins (B12, B1) that is documented to be the cause. In order to reverse this nutritional deficit, your doctor may recommend B- vitamin supplements.  In our office, we carry Neuremedy, which is benfotiamine, an active form of thiamine, which helps nerves function properly.  We recommend a loading dose the first month and then maintenance after that.  The Neuremedy can also be used in other instances of neuropathy and many of our diabetic patients do use it.

  1. Idiopathic Neuropathy

Sometimes there is no rhyme or reason as to why a patient would have peripheral neuropathy, and in those cases, it is referred to as idiopathic, or of unknown cause.  In those cases, since no origin is known, it is difficult to know how to treat it.  The symptoms of burning, aching, tingling, or pins and needles is the same. 

What Is The Treatment For Peripheral Neuropathy?

There are various treatment options for peripheral neuropathy.  But first, it is important to understand the underlying cause.  If the cause is known, then steps need to be taken to limit the affect. Supportive care is also important, for example your podiatrist may recommend accommodative inserts or special shoes.  The reason is because the accommodative inserts can pad the shoe and protect the feet and toes from injury and cushion areas of friction to prevent a blister that can progress to infection or worse, surgery and amputation.

Oral medications -  Your Neurologist or primary care physician can recommend various oral medications. There are many side effects with these medications and they need to be monitored closely. 

Topical medications - Your podiatrist can recommend some topical medications, both over the counter and prescription topicals.  Prairie Path Foot and Ankle Clinic works with several compounding pharmacies in the area that produce a compound that may be effective in treating symptoms.  Although this does not address the cause, at least some relief can be felt.  These topical medications must be applied 3-4 times a day, and sometimes takes a few days to a week to be effective, but this definitely works for many patients.

MLS Pain Laser – this is a modality that Prairie Path Foot and Ankle clinic has to offer that is different that going to a Neurologist or primary care doctor.  It is a safe, effective way to treat peripheral neuropathy by turning light energy into biomechanical energy.  It is non-invasive and has no known side effects.  There are very few contra indications as well.  We recommend 2-3 sessions per week for several weeks and the effect is accumulative. You may feel an an immediate analgesic effect as well, but often the relief is felt after 5-6 sessions.  It is safe, pain-free, has no known side effects, and is done in the convenience of our office by our laser technicians.

If you have tingling, numbness, burning, or pins and needles in your toes or feet, you may have peripheral neuropathy.  It is important to have your feet checked out by one of the doctors here at Prairie Path Foot and Ankle Clinic.  We will make sure your treatment plan includes relief.