You might not be aware that you have this condition until you feel the symptoms— numbness or tingling in the feet or legs, pain, prickling or a burning sensation. It can also make itself known as weakness, loss of balance or changes in the shape of your feet. The condition is called peripheral neuropathy— which is a fancy way of saying damage to the nerves in the extremities (feet, legs, arms or hands).
This is often caused by nerve damage from diabetes. Even diabetic patients with excellent management of the disease may develop neuropathy.
The disease can also present itself as hyper-sensitivity. Instead of feeling numb, a patient can become overly sensitive to the slightest touch. One of our patients reported that the feel of the lightest bed-sheet at night felt excruciating.
From the Bottom up
Let’s start at the bottom. Nerves in your lower extremities (feet or legs) send messages to the brain, such as a warning that the feet are cold. Peripheral nerves also carry signals to the muscles from the brain and spinal cord, such as orders to move. Like static on a telephone line, peripheral neuropathy interferes with the transmission of these messages.
This can be dangerous for diabetics because they may not realize they have an injury. For instance, if you cut your foot and you can’t feel the pain, you can develop an infection. (An infection can also cause peripheral neuropathy.) The U.S. government estimates that 60 to 70 percent of people with diabetes have mild to severe nerve damage.
In diabetic neuropathy, the damage can occur from the farthest reaches (like the toes) and spread on up the body. Pain and numbness are often noticed first in the feet. Then there’s a gradual progression up the legs until the fingers, hands and arms are affected. The damage can involve only one nerve or multiple nerves. It can happen to different parts of the nerve. One of our tasks at the clinic is to help trace exactly where and how the damage is occurring.
An Accident with a Long Tail
There are other possible causes of peripheral neuropathy. Children who have fallen off a bike or teenagers who were involved in a car crash can be diagnosed as adults. Peripheral neuropathy can be caused by trauma as well as disease, and it can take years to develop.
Another source of the syndrome is repetitive stress. If you work, for instance, at a factory and your job involves pressing a foot pedal hour after hour, day after day, nerves can become compressed and eventually damaged.
Various disorders such as kidney disease can also be characterized by peripheral neuropathy.
Exams and Tests Confirm the Condition
Because the symptoms of peripheral neuropathy vary so widely— from numbness to hypersensitivity, for instance— we use a variety of tools to confirm the diagnosis. First is a thorough medical and neurological exam. Then we need a complete medical history, including information about your work, alcohol use, disease in your family, social habits, exposure to toxins and other factors. Tests of muscle strength and an evaluation of sensory abilities are also important. A blood test can detect diabetes, liver or kidney dysfunction, vitamin deficiencies and metabolic disorders.
Sometimes the doctor will order an EMG, MRI or other imaging tests.
Treating peripheral neuropathy involves treating any underlying condition like infection, hormone or vitamin deficiencies, autoimmune disorders or nerve compression. If the patient has diabetes, we need to get the blood sugar under control.
The good news is, damage to the peripheral nerves often heals itself once the underlying condition is corrected. In the meantime, there are exercises that can relieve pain or cramps and increase your muscle tone. If you smoke, it’s important to quit because smoking constricts the blood vessels that nourish your nerves. Drinking alcohol to excess if also a risk factor.
The bottom line is, If you have loss of feeling in your feet or legs, or tingling or cramping at night, contact our clinic and make an appointment to see one of our specialists. Sooner is better, when it comes to peripheral neuropathy.