Definition

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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Causes

Many diseases and conditions can cause peripheral neuropathy. The damage may occur due to:

  • Malnutrition
  • Compression
  • Cancer
  • Trauma
  • Inflammation
  • Infection
  • Toxins
  • Medications
  • Hereditary syndromes
  • Unknown causes

Diseases that can damage peripheral nerves include (but are not limited to):

Compression commonly occurs when nerves are pinched or trapped somewhere along their course, such as:

Toxins that can damage the peripheral nerves include:

Many medicines can lead to peripheral neuropathy. A partial list includes:

Other causes of peripheral nerve damage include:

  • Vitamin deficiencies ( thiamin and B12 deficiency , often related to alcoholism, and vitamin E deficiency)
  • Injury
  • A tumor pressing on a nerve
  • Exposure to cold or radiation
  • Leprosy
  • Acute or chronic demyelinating polyneuropathy
  • Porphyria
  • Paraneoplatic syndromes
  • Genetic disorders ( Charcot-Marie-Tooth disease , Dejerine-Sottas disease, and Refsum’s disease)
  • Prolonged treatment in the intensive care unit

Risk Factors

These factors increase your chance of developing this condition. Tell your doctor if you have any of these risk factors:

  • Diabetes (about 60% of people with diabetes have peripheral neuropathy)
  • Alcohol abuse
  • Autoimmune diseases, such as rheumatoid arthritis or celiac sprue
  • Family member with peripheral neuropathy
  • Exposure to toxins or medications known to cause neuropathy
  • Vitamin deficiency (thiamin and vitamin B12)
  • HIV infection
  • Pressure on a nerve (may occur with repetitive stress injuries)
  • Hospitalization treatment in the intensive care unit

Symptoms

Damage to the peripheral nerves often results in sensory (feeling) and motor (strength) symptoms in the:

  • Arms
  • Legs
  • Hands
  • Feet

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 (eg, from the feet to the calves).

Symptoms include:

  • Numbness or reduced sensation
  • Tingling
  • Pain, often a burning or sharp, cutting sensation
  • Sensitivity to touch
  • Muscle twitches
  • Muscle weakness
  • Muscle cramping
  • Difficulty with walking
  • Loss of coordination or balance
  • Paralysis

If untreated, peripheral neuropathy can lead to:

  • Loss of reflexes and muscle control
  • Muscle atrophy (loss of muscle bulk)
  • Foot deformities
  • Foot ulcers
  • Injuries to the feet that go unnoticed and become infected
  • Autonomic dysfunction (sweating, bowel and bladder dysfunction, cardiovascular effects)
  • Difficulty breathing

Diagnosis

The doctor will ask about your symptoms and medical history. She will also do a physical exam, which may include:

  • Muscle strength
  • Reflexes
  • Balance
  • Coordination
  • Ability to feel vibration, temperature, and light touch
  • Semmes-Weinstein monofilaments test—measures sensation in the feet using a fine flexible wire

Additional tests may also include:

  • Blood tests (including glucose, vitamin B12 level, and thyroid function tests)
  • Electromyography (EMG) —measures and records electrical activity generated in muscle in response to nerve stimulation
  • Nerve conduction studies (NCS) —measures the speed and degree of electrical activity in a nerve to determine if it is functioning normally
  • Serum/urine electrophoresis (protein analysis)
  • Genetic testing
  • Evaluation of family members
  • Spinal tap (lumbar puncture, LP)
  • Nerve or muscle biopsy (rarely)

Treatment

Treatment may include:

Treatment for the Underlying Illness or Exposure

Treating the underlying illness can decrease or eliminate symptoms. 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.

Physical Therapy

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 (supports and braces) may help with:

  • Deformities
  • Balance issues
  • Muscle weakness

Maintaining physical activity is also key.

Medications

Prescription and over-the-counter (OTC) pain medicines are often used to ease discomfort.

Drugs to treat depression 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 (Neurontin)
  • Carbamazepine (Tegretol)
    • 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 (Lyrica)—recently approved for peripheral neuropathy

For severe and potentially life-threatening cases (such as Guillain-Barre syndrome ), treatment includes:

  • Steroids (such as prednisone )
  • Intravenous immunoglobulins

Other Therapies

These therapies are aimed at reducing symptoms and may include:

Surgery

Surgery can relieve the pressure on nerves. For example, surgeons commonly release fibrous bands in the wrist to treat carpal tunnel syndrome .

Prevention

  • Manage chronic medical conditions with the help of your doctor. If you have diabetes, visit a podiatrist for yearly exams.
  • Eat a healthful diet , one 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.
  • Avoid:
    • Toxic chemicals
    • Repetitive movements
    • Prolonged pressure on joints, especially elbows and knees