What is Peripheral Neuropathy?

Peripheral neuropathy is a disease of the nerves. It most often starts in your feet and may also eventually affect the arms. It can affect sensory, motor, or both functions. It may cause pain or make you unable to sense pain. Sometimes weakness occurs as well. Lack of pain and weakness makes you more likely to injure yourself without knowing it. But you can learn ways to protect your feet from injury.

Nerves that control bodily functions such as blood pressure, sweating, and heart rate are called autonomic nerves. Neuropathy can also affect these nerves and cause serious disability.

When nerves are diseased

Nerves in your feet carry signals to your brain. Your brain reads those signals and interprets them as sensations. When nerves in your feet are diseased, signals may be disrupted or changed. The result may be a lack of feeling (numbness) in your feet or other symptoms, such as tingling or pain.

Symptoms mask pain

Symptoms of peripheral neuropathy usually start in your toes. The symptoms slowly spread up your feet and legs as more nerve is affected. These symptoms may decrease sensation in your feet or mask pain. Without pain, you may not notice a cut or even a bone fracture. Cuts may become infected. Fractures may heal poorly and lead to foot deformity.

Top view of foot partly to the side showing bones and nerves. Forefoot is shaded in.
Peripheral neuropathy symptoms often start in the toes and move up the foot.

Common causes of peripheral neuropathy

Some common causes of peripheral neuropathy include:

  • Diabetes or other endocrine disorders

  • Toxins (such as alcohol)

  • Nutritional deficiencies (such as Vitamin B-12)

  • Kidney disease

  • Injury

  • Repetitive stress (such as carpal tunnel syndrome)

  • Autoimmune disease

  • Cancer and tumors

  • Chemotherapy cancer treatment

  • Arthritis

  • Advanced age

  • Hereditary disorders

  • Neurological disorders

  • Infection

  • Loss of balance

  • Passing out when standing too fast

Diagnosis and treatment

Diagnosis of peripheral neuropathy includes a complete history and physical exam. Tests include blood tests and imaging often help find the cause. Special nerve tests are often helpful including nerve conduction velocity studies (NCV), and electromyography (EMG). NCV helps find evidence of poor conduction of nerve signals. EMG helps tell whether symptoms are caused by muscle or nerve disorders. Genetic tests can be done if your healthcare provider suspects a hereditary neuropathy.

Treatment focuses on treating the underlying disorder and treating the symptoms using medicines, injections, TENS (transcutaneous electrical nerve stimulation), acupuncture, massage, and others.

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