Peripheral Neuropathy – Causes and Effects

Introduction

Peripheral Neuropathy, a condition affecting millions worldwide, is a lesser-known but significant health concern. 

This condition can have a profound impact on your daily life.

At Dynamic Podiatry we see people every week who are suffering from the effects of peripheral neuropathy. 

Whether it’s pain, numbness, weakness, or loss of balance, we see it regularly.

In this blog post, we will delve into the complexities of Peripheral Neuropathy in the feet, exploring:

  • its stages,
  • common causes,
  • associated dangers,
  • precautions,
  • the importance of seeking podiatric care, and
  • available treatments. 

By increasing your understanding of this condition, you can take proactive steps to manage and potentially prevent its debilitating effects.

 

What is Peripheral Neuropathy?

Peripheral Neuropathy is a condition that damages the peripheral nerves (typically those in your feet and hands), which are responsible for transmitting signals between the central nervous system and the rest of the body, including the limbs.

These nerves are important as they let us know about any dangers such as heat, sharp objects etc.

When these nerves are damaged, they can lead to disruptions in sensation, muscle control, and our balance.

Stages of Peripheral Neuropathy

Early Stages: Numbness and Tingling

In the initial stages of Peripheral Neuropathy, patients may experience mild symptoms, such as tingling or numbness in the feet. 

Discomfort may be sporadic, leading many individuals to ignore the warning signs.

Progression: Sharp and Burning Pain

As the condition progresses, the tingling and numbness may transform into sharp, shooting pains and a burning sensation. 

These symptoms can significantly impact daily activities and reduce overall quality of life.

A foot is wrapped in barbed wire which is how your feet can feel with Peripheral Neuropathy

Advanced Stages: Loss of Sensation and Muscle Weakness

In advanced cases, individuals may lose sensation in their feet, making them more susceptible to injuries or infections. 

Muscle weakness can lead to difficulties walking and maintaining balance, increasing the risk of falls and accidents.

 

Common Causes of Peripheral Neuropathy

Diabetes and its Impact on Foot Health

A diagram showing the affects on different body parts of diabetes

Diabetes is a leading cause of Peripheral Neuropathy, (and the one we most commonly see) with elevated blood sugar levels contributing to nerve damage over time. 

Good control of your blood glucose levels and regular exercise are the best ways to prevent diabetes causing peripheral neuropathy.

Nutritional Deficiencies and Nerve Damage

Deficiencies in essential nutrients like vitamin B12 and folic acid can lead to nerve damage and contribute to the development of Peripheral Neuropathy.

In some people this can occur due to heavy alcohol consumption.

Injuries and Trauma to the Feet or Spine.

Physical injuries, such as fractures or compression of nerves due to repetitive motion, can cause Peripheral Neuropathy.

Compression of the nerve root at the spinal level can also cause peripheral neuropathy.

Autoimmune Diseases and Their Effects on Peripheral Nerves

Certain autoimmune disorders, such as Rheumatoid Arthritis, Crohn’s Disease and Lupus, can trigger inflammation and damage to the peripheral nerves.

These conditions are best managed by your family doctor and/or a specialist physician.

Dangers Associated with Peripheral Neuropathy

Increased Risk of Foot Infections and Ulcers

With decreased sensation in the feet, individuals with Peripheral Neuropathy may not notice cuts, sores, or blisters, leading to infections and ulcers that can be difficult to heal.

This is one of the most common problems we see people run into. 

If peripheral neuropathy gets to the stage where you cannot sense when your skin if being broken, you will not know when a sore or ulcer has developed.

 

Complications Leading to Amputation

If left untreated, infections of the bone can get to the stage where they require amputation to prevent the spread of infection.

This can be just one toe, or it could be an amputation just below the knee.

Amputations have a massive impact on someone’s ability to lead a fulfilling life and can hasten one’s death.

Impaired Balance and Increased Fall Risk

Muscle weakness and loss of sensation in the feet can affect balance, increasing the risk of falls, especially in older individuals.

Especially on uneven surfaces, often your body will not correct itself quickly enough and you can fall.

An elderly man with a cane is assisted walking by a young man.

Falls themselves can lead to a catastrophic change in lifestyle, and if they cause a fracture of the hip bone, they will lead to hospitalisation.

Read more about falls risk here.

Negative Impact on Quality of Life

Chronic pain and mobility issues caused by Peripheral Neuropathy can significantly impact a person’s emotional well-being and overall quality of life.

Precautions to Follow if You Have Peripheral Neuropathy

Daily Foot Care Routine

Establishing a daily foot care routine is essential for managing Peripheral Neuropathy. 

This includes regular inspection of the feet, washing and drying them carefully, and applying moisturiser to prevent cracks and dryness.

If you have difficulty seeing the bottom of your own feet, either asking a relative to help, or using a small mirror on the floor can help.

The important thing is to get to a doctor quickly if you notice any changes including: blood or pus, swelling, increased redness, or a visible wound.

Footwear Selection and Importance of Proper Support

Choosing appropriate footwear with adequate support and cushioning can reduce pressure on the feet and minimise the risk of injuries.

Some of the features of an appropriate shoe are:

  • leather upper to protect you from dropped objects, especially in places like the kitchen or workshop,
  • laces or velcro to keep them on your feet,
  • relatively light weight,
  • a deep heel cup to support your heels.

Avoiding Extreme Temperatures and Injuries

Peripheral Neuropathy can reduce the ability to sense temperature changes, so it is crucial to avoid extreme heat or cold to prevent burns or frostbite.

I once had a patient who walked across a burning hot road, barefoot, in the middle of summer because he couldn’t feel it.

 

He had severe burns which had to be dressed every second day for several months.

Make sure that your hot water system is turned down to the legal temperature so that you don’t burn yourself in the shower or bath.

A person wearing a pair of boots in the snow

Why You Should See a Podiatrist if You Have Peripheral Neuropathy

Specialised Foot Care for Neuropathy Patients

Podiatrists are experts in foot health and can provide specialised care and treatments tailored to individuals with Peripheral Neuropathy.

Expert Diagnosis and Monitoring

One of the most important things that we do for people with peripheral neuropathy is to accurately measure their sensitivity to light touch and vibration.

This helps us to know if the peripheral neuropathy has advanced enough to prevent you from being able to feel when your feet are injured.

We also regularly check the blood supply to your feet using high tech equipment including a doppler ultrasound to check flow, and a PPG (photoplethysmogram) to find the tiniest arteries in your toes.

This helps us to understand how quickly you will heal from an injury and also how likely you are to have an ulcer occur.

Read more on the testing we provide for people with peripheral neuropathy here.

A podiatrist is performing a test of a patient's blood flow

This helps us to understand how quickly you will heal from an injury and also how likely you are to have an ulcer occur.

Read more on the testing we provide for people with peripheral neuropathy here.

Preventative Measures and Treatment Plans

We have the expertise to tailor a management plan specific to YOU and YOUR lifestyle.

We recognise that not only is everyone different, but everyone’s goals are also different. 

You may still want to travel, or play sport, or many other things. Our job as Podiatrists is to make sure that you can live the life that YOU want to live, safely, and without putting your health at risk.

Some of the things we may build into your plan have been mentioned above:

  • footwear selection,
  • daily monitoring of your feet,
  • regular nail and skin treatments including debridement of callouses on pressure areas.

We may also incorporate pressure offloading. Sometimes there will be a bony area which is at more risk than other parts of your feet.

A custom foot orthotic on a teal background
We can reduce the amount of pressure on these higher risk areas a few different ways:
  • offloading padding attached to your shoe insole. The padding may have a cut-out area where the at risk anatomy can sit,
  • accommodative orthotics – similar to padding but made using 3D laser scans of your feet.
    These are more versatile as you can swap them in and out of your various shoes, they are more effective because they use your foot shape, and they will last longer.

Read more about custom foot orthotics here.

Importance of Early Intervention to Prevent Complications

Timely intervention can significantly reduce the risk of severe complications, such as foot ulcers or amputations.

When your nerves aren’t giving you as much feedback as they once did, your foot tends to be under pressure in specific areas because it is no longer performing tiny corrections in pressure off-loading.

This can start as quite a benign area of callous, which many people without peripheral neuropathy will also get.

But if the pressure continues unabated and there is no removal of the callous – it can build up to such a state that it will actually break through the skin.

This is how a pressure ulcer (neuropathic ulcer) is formed.

The break in the skin allows all types of bacteria and fungi and yeasts that live on the feet to now penetrate the body, often taking up residence in:

  • Local soft tissue – cellulitis – shows up as a red area on the skin,
  • Bone – osteomyelitis – only seen on x-ray and can lead to amputation being necessary.
  • Lymph tissue – lymphangitis – presents as a red line going up from the foot (can also be underneath the foot and go unnoticed),
  • Lymph nodes – lymphadenitis – causes swelling and warmth behind the knee or in the groin,
  • or the blood stream – septicaemia – can lead to death.
It is clear from this list the very severe effects that peripheral neuropathy can have.

Treatment for Peripheral Neuropathy

Physical Therapy and Exercise Regimens

Physical therapy and targeted exercises can strengthen muscles and improve balance, helping to manage symptoms and enhance overall mobility.

Some people also get some relief by mobilising their ankles performing simple exercises like paddling their feet up and down, or making circular movements with their feet. 

This increases blood flow to the area, and helps the joints to feel freer.

Debridement (scalpelling) of Callouses and Corns

I mentioned above how dangerous the cascade of events can be if you have areas of pressure causing callouses and corns which are undetected or untreated.

Podiatrists treat and maintain these areas by a combination of sharp debridement and pressure offloading (mentioned above in prevention).

By sharp debridement we remove layers of callous at regular intervals (often 6 weekly) to ensure that they don’t grow fast enough to cause an ulcer.

Offloading also slows the rate of growth of callouses and corns.

A neuropathic ulcer on the bottom of the ball of a foot.
A Diabetic Foot Wound. This arose from a lack of sensation in the feet from Diabetes.

Dietary Changes to Support Nerve Function

Consuming a balanced diet rich in vitamins and minerals can promote nerve health and potentially slow the progression of Peripheral Neuropathy.

This can be one of the most important factors.

We highly recommend that you speak to your family doctor or to a dietician/nutritionist for personalised advice.

Pain Management Techniques

Some individuals may find relief through alternative therapies like acupuncture, biofeedback, or relaxation techniques to manage pain and stress.

Exercises like Tai Chi and Yoga have the advantage of improving your balance as well as your overall wellbeing.

Medications for Pain Relief and Nerve Health

Certain medications can help manage pain and improve nerve function in individuals with Peripheral Neuropathy.

Your family doctor or specialist physician is definitely the person to go to for help with medications. Many people find that with the help of some medication, their life becomes much more enjoyable.

Conclusion

Peripheral Neuropathy in the feet can be a challenging condition to manage, but with the right knowledge and proactive care, you can take control of your foot health and overall well-being.

Understanding the stages, causes, and dangers associated with Peripheral Neuropathy empowers you to seek timely medical attention, adopt preventive measures, and explore appropriate treatments to mitigate its impact on your life.

Consulting a podiatrist, family doctor and specialists as required, and adhering to a comprehensive care plan can pave the way towards stepping out of the shadows of Peripheral Neuropathy and regaining a fulfilling, pain-free life.

To book an appointment with one of our caring podiatrists click the booking button below.

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Disclaimer

The advice on this page and the website dynamicpodiatry.com.au is general in nature and should not be considered as medical advice, but for informational and educational purposes only.
Although we are podiatrists, unless you are a patient of our clinic and have been given the advice directly, then it may not be suitable for you.
Please consult your podiatrist or medical practitioner before taking on any of the advice given.