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 diseases and conditions can cause peripheral neuropathy. The damage may occur due to: MalnutritionCompression from repetitive stressCancerTraumaInflammation of nerves or blood vesselsInfectionToxinsMedicationsHereditary syndromesUnknown causes
Diseases that can damage peripheral nerves include (but are not limited to):
type 2AlcoholismAIDSLyme diseaseRheumatoid arthritis
Uremia from chronic
kidney failureAutoimmune disordersHypothyroidism
Viral infections like
Compression commonly occurs when nerves are pinched or trapped somewhere along their course, such as: Carpal tunnel syndrome
—nerve in the wrist
—nerve roots forming the sciatic nerve in the back of the legs as they exit the spine
Toxins that can damage the peripheral nerves include: LeadMercuryThalliumOrganic solventsPesticidesCarbon disulfideArsenicAcrylamideDiphtheria
Many medicines can lead to peripheral neuropathy. A partial list includes: Chemotherapeutic agents
to treat cancer, such as vincristine,
Anti-HIV medications, such as didanosine and
medications, such as isoniazid and ethambutol
Other antimicrobial drugs such as dapsone, metronidazole
and chloramphenicolPsychiatric medications, such as lithium
Other medications, such as
hydralazine, and high levels of
Other causes of peripheral nerve damage include:
Vitamin deficiencies, such as
InjuryA tumor pressing on a nerveExposure to cold or radiationLeprosyAcute or chronic
demyelinating polyneuropathyPorphyriaParaneoplatic syndromes
Genetic disorders, such as
or hereditary motor and sensory neuropathy
Prolonged treatment in the intensive care unit
Factors that may increase your risk of getting peripheral neuropathy include: DiabetesAlcohol abuse
Autoimmune diseases, such as
celiac sprueFamily member with peripheral neuropathyExposure to toxins or medications known to cause neuropathyVitamin deficiency, such as thiamin and vitamin B12HIV infectionPressure on a nerve—may occur with repetitive stress injuriesHospitalization treatment in the intensive care unit
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.
Symptoms include: Numbness or reduced sensationTinglingPain, often a burning or sharp, cutting sensationSensitivity to touchMuscle twitchesMuscle weaknessMuscle crampingDifficulty with walkingLoss of coordination or balanceParalysis
If untreated, peripheral neuropathy can lead to: Loss of reflexes and muscle controlMuscle atrophy—loss of muscle bulkFoot deformitiesFoot ulcersInjuries to the feet that go unnoticed and become infectedAutonomic dysfunction—sweating, bowel and bladder dysfunction, cardiovascular effectsDifficulty breathing
If you have motor or sensory neuropathy, you may also have autonomic neuropathy. This is associated with symptoms such as: Problems regulating blood pressureConstipationErectile dysfunction
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 touchSemmes-Weinstein monofilaments test—measures sensation in the feet using a fine flexible wire
Additional tests may also include:
You may need to have tests of your bodily fluids and tissues. This can be done with:
Blood tests, such as glucose, vitamin B12 level, and thyroid function testsSerum/urine electrophoresisGenetic testingSpinal tap
, also called a lumbar puncture
Nerve or muscle
Nerve fiber density skin biopsy
You may need to have your nerves and muscles tested. This can be done with:
Electromyography (EMG)Nerve conduction studies (NCS)
You may need to have pictures taken of your bodily structures. This can be done with:
MRI scanCT scanYour doctor may need to evaluate other family members for this condition.
Treatment 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 (OTC) pain medicines are often used to ease discomfort.
Drugs to treat
and prevent convulsions sometimes relieve neuropathy symptoms. These medicines are often given at lower dosages.
Commonly used antidepressants include:
Commonly used anticonvulsants may include: Gabapentin
According to the Food and Drug Administration (FDA), patients of Asian ancestry who have a certain gene, called HLA-B*1502, and take carbamazepine are at risk for dangerous or even fatal skin reactions. If you are of Asian descent, the FDA recommends that you get tested for this gene before taking carbamazepine. If you have been taking this medication for a few months with no skin reactions, then you are at low risk of developing these reactions. Talk to your doctor before stopping this medication.Pregabalin
For severe and potentially life-threatening cases, such as
, treatment includes:
—done to exchange plasma in the blood
These therapies are aimed at reducing symptoms: Relaxation trainingBiofeedbackWalkingExerciseYogaWarm bathsMassageAcupunctureTranscutaneous electronic nerve stimulation
Surgery can relieve the pressure on nerves. For example, surgeons commonly release fibrous bands in the wrist to treat
carpal tunnel syndrome
Manage chronic medical conditions with the help of your doctor. If you have diabetes, visit a podiatrist for yearly exams.
that is low in saturated fat and rich in whole grains, fruits, and vegetables.
Be sure to get the right amounts of thiamin and vitamin B12.Limit your alcohol intake to a moderate level. This means two or fewer drinks per day for men and one or fewer for women.
Toxic chemicalsRepetitive movementsProlonged pressure on joints, especially elbows and knees
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Last reviewed March 2013 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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