No Sense, No Feeling? Peripheral Neuropathy

What is neuropathy?

The nervous system sends and receives messages throughout your entire body.  Neuropathy occurs when this system does not work properly. Peripheral neuropathy refers to the peripheral nerves in the extremities (i.e. your fingers and toes).  There are many types of neuropathy, each with different causes and symptoms. 

Neuropathy can affect the sensory nerves, motor nerves and the autonomic nerves. Symptoms can vary dependent on the type of nerve affected. 

Sensory neuropathy can present as:

• Pins and needles in the affected region
• Numbness
• Reduced ability to feel pain or changes in temperature
• Hypersensitivity, ie feeling pain from a stimulus that should not be painful
• Loss of balance or co-ordination.

Motor neuropathy symptoms include muscle cramping, muscle weakness or paralysis, wasting of the muscles and foot drop, which is lifting up the front part of the foot and toes when walking.

Autonomic neuropathy affects the digestive and cardiovascular system.  In the feet, the most common symptom is lack of, or excessive, sweating.

Causes of neuropathy

The types of conditions causing neuropathy include autoimmune diseases, diabetes, infections and inherited disorders.

Another common cause is trauma to the nerve.  Often the nerve damage occurs higher up the nervous system eg. sciatica in the back can cause neuropathy in the feet. 

Lifestyle and environmental factors can also impact on the function of nerves and increase your risk of future neuropathy.  These include:

• excessive alcohol consumption which can reduce the efficiency and effectiveness of the nerves and may eventually lead to peripheral neuropathy
• vitamin deficiency, such as vitamin B12 which is important in maintaining good health in the nerves 
• certain medication can affect the receiving and sending of messages around the nervous system.

What can my podiatrist do for me?

Your podiatrist will review your medical history, including your symptoms, your lifestyle, drinking habits and a family history of nervous system (neurological) disorders.  The thorough detail is important to help determine the cause of your tingling toes.  We may also check your tendon reflexes, your muscle strength and tone, your ability to feel certain sensations, and your posture and coordination.

The various tests and examinations will help us to build a picture of your neurological status.  If you have a known medical condition like diabetes, the results of the tests will be used as a baseline to assess the deterioration of your neurological status.  

Neuropathy caused by lifestyle factors can often be improved, or at least stabilised, by making changes.  Cases of neuropathy which are caused by underlying conditions will need expert medical help.  If we are not able to help directly, the results of our tests will give us an indication of possible causes and help us to signpost you in the right direction for further investigation.

Looking after your numb feet

Whatever the cause of your peripheral neuropathy, having numb feet can cause other problems.  Wounds that you don’t notice can get infected or ulcerated.  It is therefore very important to follow this advice if you have a lack of feeling in your feet:

• Inspect your feet daily for cracks, cuts or blemishes – if you can’t get down to them, ask someone to help or use a mirror.
• Never walk around bare-footed.
• Don’t use your toes to check the temperature of bath water before getting in.  You could inadvertently scald yourself.
• Don’t use hot water bottles on bare skin.
• Check inside your shoes before putting them on, to ensure there is nothing inside that could injure your foot.
• Keep skin well moisturised to avoid cracking.

If you have any concerns about a lack of feeling or strange sensations in your feet, speak to your podiatrist, who can advise you further.