Peripheral neuropathy is damage to the peripheral nerves. These are the nerves that connect your spinal cord to the rest of your body.
Peripheral Nerves of the Foot
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Many health conditions can cause peripheral neuropathy. The damage may the result of: Trauma
nerve compression or inflammation
Certain medications, such as chemotherapy treatments for cancerVitamin deficienciesHereditary syndromes
Exposure to toxins and heavy metals, such as
mercury, or pesticides
Exposure to cold or radiationProlonged treatment in the intensive care unit
Health conditions that can damage peripheral nerves include: Type 1
Infections, such as
tuberculosis, or leprosy
kidney failureAlcohol use disorder
Autoimmune disorders, such as
rheumatoid arthritisAcute or chronic
demyelinating polyneuropathyPorphyriaParaneoplastic syndromes
Having certain health conditions may increase your chance of getting peripheral neuropathy.
Damage to the peripheral nerves often results in sensory and motor symptoms in the: ArmsLegsHandsFeet
Other parts of the body can also be affected. Symptoms depend on which nerves are involved. They can range from mild to severe and may seem worse at night. Sensations and pain may occur in the upper or lower limbs and move toward the trunk, such as from the feet to the calves.
Peripheral neuropathy may cause: Numbness or reduced sensationTinglingPain, often a burning or sharp, cutting sensationSensitivity to touchMuscle twitchesMuscle weaknessDifficulty with walkingLoss of coordination or balanceParalysis
If untreated, peripheral neuropathy can lead to: Loss of reflexes and muscle controlMuscle atrophy—loss of muscle bulkFoot deformitiesInjuries to the feet that go unnoticed and become infected
If you have motor or sensory neuropathy, you may also have autonomic neuropathy. This is associated with symptoms, such as: Problems regulating blood pressureConstipationErectile dysfunctionDifficulty breathing
The doctor will ask about your symptoms and medical history. A physical exam will be done. It may include examining: Muscle strengthReflexesBalanceCoordinationAbility to feel vibration, temperature, and light touchSensation in the feet using a fine flexible wire—Semmes-Weinstein monofilaments test
Additional tests may also include:
Tests of your bodily fluids and tissues:
Blood tests, such as glucose, vitamin B12 level, and thyroid function testsSerum/urine electrophoresisGenetic testingLumbar punctureNerve fiber density skin biopsy
Nerve or muscle
Evaluation of your nerves and muscles:
Nerve conduction studies
Imaging tests to evaluate nerves and other structures:
MRI scanCT scan
Your doctor may need to evaluate other family members for this condition.
Talk with your doctor about the best treatment plan for you. Options may include:
Treating the underlying illness can decrease symptoms or make them go away. For instance, if it is caused by diabetes, controlling blood sugar levels may help. In some cases, neuropathy caused by medications or toxins is completely reversed when these substances are stopped or avoided. Correction of vitamin B12 deficiency often improves symptoms.
Certain exercises may help stretch shortened or contracted muscles and increase joint flexibility. In long-standing cases, splinting the joint may be required to protect and rest it, while maintaining proper alignment.
Orthotics, such as supports and braces, may help with: DeformitiesBalance issuesMuscle weakness
Maintaining physical activity is also important.
Prescription and over-the-counter pain medications are often used to ease discomfort. Botulinum toxin A injections may also be given to help reduce pain.
Medications used to treat
and prevent convulsions can
relieve neuropathy symptoms.
For severe and potentially life-threatening cases, such as
Guillain-Barre syndrome, treatment includes:
Plasma exchange of the blood—plasmapheresis
These therapies are aimed at reducing symptoms: Relaxation trainingBiofeedbackWalking
and other exerciseYogaWarm bathsMassageAcupunctureTranscutaneous electronic nerve stimulation (TENS)
Surgery can relieve the pressure on nerves. For example, surgeons commonly release fibrous bands in the wrist to treat
carpal tunnel syndrome.
To help reduce your chance of peripheral neuropathy: Manage chronic medical conditions with the help of your doctor. If you have diabetes, make sure you have regular foot exams.
that is low in saturated fat and rich in whole grains, fruits, and vegetables.
Limit your alcohol intake to a moderate level. This means two or less drinks per day for men and one or less per day for women.Avoid
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Diabetic neuropathies: The nerve damage of diabetes.
National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:
http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diabetic-neuropathies-nerve-damage-diabetes/Pages/diabetic-neuropathies-nerve-damage.aspx. Updated November 26, 2013. Accessed May 30, 2014.
Karlsson P, Møller AT, Jensen TS, Nyengaard JR. Epidermal nerve fiber length density estimation using global spatial sampling in healthy subjects and neuropathy patients.
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12/1/2016 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T474253/Peripheral-neuropathy: Attal N, de Andrade DC, et al. Safety and efficacy of repeated injections of botulinum toxin A in peripheral neuropathic pain (BOTNEP): a randomized, double-blind, placebo-controlled trial. Lancet Neurol. 2016 May;15(6):555-565.
Last reviewed September 2016 by Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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