Understanding Neuropathy, One Clear Article at a Time

What Is Peripheral Neuropathy? A Plain-English Guide

Your nervous system has two main parts. The central nervous system is the brain and spinal cord. The peripheral nervous system is the network of nerves that branches out from there to your arms, legs, hands, feet, skin and internal organs.

Peripheral neuropathy is the general term for damage or dysfunction in those peripheral nerves. It is not a single disease but a result that can come from many different causes.

Three types of nerves can be affected

• Sensory nerves carry sensations such as touch, temperature, vibration and pain.
• Motor nerves control muscle movement.
• Autonomic nerves regulate automatic functions such as blood pressure, digestion, sweating and bladder control.

Neuropathy can affect one nerve (mononeuropathy), several separate nerves (multiple mononeuropathy) or many nerves at once (polyneuropathy). Polyneuropathy is the most common form, and it usually starts in the feet.

Common Symptoms of Neuropathy and How They Progress

Symptoms depend on which nerves are involved. Many people first notice changes in their toes or the soles of their feet.

Sensory symptoms

• Tingling, "pins and needles" or a buzzing feeling
• Numbness or reduced ability to feel temperature or pain
• Burning, sharp, stabbing or electric-shock-like pain
• Extreme sensitivity to touch, even from bedsheets
• A feeling of wearing socks or gloves when you are not

Motor symptoms

• Muscle weakness or cramps
• Loss of balance or coordination, more frequent falls

Autonomic symptoms

• Dizziness when standing up
• Changes in sweating, digestion, bladder or sexual function

The "stocking-glove" pattern

In the most common form, symptoms begin in both feet and slowly move upward. Later the hands may be affected. This pattern happens because the longest nerves are usually the first to be damaged.

What Causes Neuropathy? The Most Common Triggers

There are more than a hundred known causes of peripheral neuropathy. Some of the most common include:

• Diabetes. The leading cause in the United States. Prolonged high blood sugar can damage nerves and the small blood vessels that nourish them.
• Vitamin deficiencies, especially vitamin B12, but also B1, B6 and E.
• Heavy alcohol use, which can be toxic to nerves and is often linked to poor nutrition.
• Certain medications, including some chemotherapy drugs and some antibiotics.
• Autoimmune conditions such as rheumatoid arthritis, lupus, Sjögren's syndrome and Guillain-Barré syndrome.
• Infections such as shingles, HIV, hepatitis C and Lyme disease.
• Kidney disease, liver disease and an underactive thyroid.
• Inherited conditions, such as Charcot-Marie-Tooth disease.
• Injury or pressure on a nerve, as in carpal tunnel syndrome.

In a meaningful share of people, no cause is found even after testing. This is called idiopathic neuropathy.

How Neuropathy Is Diagnosed

There is no single test for neuropathy. Doctors usually combine several steps:

• Medical history: symptoms, how they started, health conditions, medications, alcohol use and family history.
• Neurological exam: reflexes, muscle strength, balance and the ability to feel touch, vibration and temperature.
• Blood tests: commonly blood sugar, vitamin B12, thyroid function, and kidney and liver markers.
• Nerve conduction studies and electromyography (EMG): measure how well electrical signals travel through nerves and muscles.
• Other tests when needed: imaging, a skin biopsy to look at small nerve fibers, or, less often, a nerve biopsy.

Bringing a written list of your symptoms, when they began and all medications and supplements you take can make the appointment more productive.

Neuropathy Treatment: An Overview of the Options

Many people search for neuropathy treatment without knowing where to start. Treatment is individual and should be guided by a licensed professional. In general, it has three goals.

1. Address the underlying cause

Examples include managing blood sugar in diabetes, correcting a vitamin deficiency, reducing alcohol, or reviewing a medication that may be contributing. Treating the cause can slow progression and, in some cases, allow partial improvement.

2. Relieve symptoms

For nerve pain, doctors may consider prescription medicines from several classes, as well as topical options. Each has its own benefits and side effects, so the choice depends on the person's health and other medications.

3. Protect function and safety

• Physical therapy to support strength and balance
• Supportive footwear and, when needed, braces or walking aids
• Regular foot checks and fall prevention at home

Daily Foot Care Habits for People with Neuropathy

When feeling in the feet is reduced, small injuries can go unnoticed and become serious. These habits are commonly recommended:

• Check both feet every day, including between the toes. Use a mirror or ask for help if needed.
• Wash feet daily with lukewarm water. Test the temperature with your elbow, not your foot.
• Dry carefully, especially between the toes, and moisturize the skin, but not between the toes.
• Wear clean, dry socks and well-fitting, closed shoes. Check inside shoes before putting them on.
• Avoid walking barefoot, even indoors.
• Trim toenails straight across, or have a professional do it.
• Report cuts, blisters, color changes or swelling to a healthcare professional quickly.

Sources and Further Reading

Articles on this blog are based on public information from recognized health organizations, including:

• National Institute of Neurological Disorders and Stroke (NINDS) – Peripheral Neuropathy
• NIDDK – Diabetic Neuropathy
• Mayo Clinic – Peripheral Neuropathy