Peripheral neuropathy is a broad term for any condition that damages the peripheral nerves that transfer sensory information and carry signals from the central nervous system in the brain and spinal cord to the rest of the body.The most common types of peripheral neuropathy affect the feet and legs. Some types progress slowly over months or years, while others develop and progress rapidly.

Types of Peripheral Nerves

Three types of nerves make up the peripheral nervous system.

• Sensory nerves carry information related to sight, hearing, taste, touch, and smell. A sensory nerve transmits information to the brain and spinal cord.
• Motor nerves carry signals away from the central nervous system to the rest of the body and control functions such as movement and muscle contractions.
• Autonomic nerves control essential but unconscious processes, such as breathing, blood pressure, digestion, and heart rate.

Symptoms of neuropathy vary according to the type of peripheral nerves affected.

Symptoms

Symptoms of peripheral neuropathy in the feet include tingling, numbness, muscle twitches and cramps, and sharp, stabbing, or burning pain. The feet may become extremely sensitive to pressure, touch, and temperature.Some people report feeling like they’re wearing socks or shoes when their feet are bare. Periods of sensitivity can alternate with periods of numbness, and symptoms may worsen at night.

Causes

Diabetes is the most common cause of peripheral neuropathy in the feet. Other potential causes include hereditary disorders, arthritis, autoimmune conditions, shingles or similar viral infections, injuries, and neurological conditions such as fibromyalgia and spina bifida.Some chemotherapy drugs and other medications may damage peripheral nerves, and excessive alcohol consumption increases the risk of nerve damage. The risk of developing neuropathy in the feet also increases with age.

Complications

Neuropathy in the feet can lead to additional medical problems. A person with peripheral neuropathy may step on sharp objects or walk around with a stone in their shoe without noticing because the nerves in the feet aren’t sending pain signals. Numbness also makes it hard to feel friction from socks or shoes that may cause blisters.Because they go unnoticed, cuts and blisters aren’t protected or treated, so small wounds can grow and infection may set in.

Diabetic Foot Ulcers

Diabetic foot ulcers are among the most common complications of peripheral neuropathy in the feet. In addition to nerve damage, long-term high blood sugar can cause poor circulation that interferes with healing. Small wounds or sores on the feet may heal very slowly or become infected.In severe cases, the infection can spread to the bone and some people require amputation. People with diabetes should regularly examine their feet and seek prompt medical attention for any wounds, even minor scrapes or cuts.

Diagnosis

Diagnosing peripheral neuropathy usually begins with a physical examination. Doctors may ask questions about symptoms, medical history, current or past medications, and daily habits. Neurological assessments check reflexes, muscle strength, and the ability to feel light touches or hot and cold temperatures.A doctor may check blood sugar levels and recommend other tests to determine the underlying cause of peripheral neuropathy affecting the feet.

Medications

Some conditions that cause neuropathy, such as an infection and vitamin deficiency, can be cured. If a cure isn’t feasible, treatment focuses on minimizing further nerve damage and relieving symptoms.Oral antidepressants or antiseizure medications and topical skin patches can help control pain. Plasma exchange or IV immune globulin procedures may help inflammatory and autoimmune disorders. Treatment for diabetic neuropathy includes keeping blood glucose levels within the recommended ranges.

Surgery and Mechanical Aids

Surgery is a possible treatment option if peripheral nerves are damaged or constricted by a physical injury or nerve entrapment disorder. Specially designed shoes, splints, and braces can provide support to improve strength and balance while walking. Mechanical aid devices may also relieve pain by keeping the nerves aligned.Doctors may recommend physical and occupational therapy to strengthen muscles, improve balance, and compensate for any lost function due to nerve damage.

Home Care

Routine foot care is important for managing neuropathy. Wear comfortable, well-fitting shoes, and wash and dry your feet thoroughly before donning clean socks or shoes. Try to avoid walking around barefoot. Examine both feet carefully every day to check for cuts, bruises, blisters or sores, swelling, or red spots.Pay special attention to the skin between the toes and monitor corns, calluses, and other patches of rough skin to make sure friction and pressure haven’t damaged the underlying tissue. Moisturizers may be helpful, but ask a doctor before adding anything to your foot care routine.

Prevention

Although neuropathy in the feet isn’t always preventable, lifestyle choices can reduce the risk- of peripheral nerve damage.Protective footwear, such as supportive closed-toe shoes or boots for work environments, may prevent injuries. Avoid tobacco products and alcohol, exercise regularly, and eat a healthy, well-balanced diet. People with diabetes can work with doctors, nutritionists, and other health care professionals to manage their blood glucose levels.