Neuropathy is a condition characterized by loss of function in one or more nerves that results in numbness, tingling, weakness, and pain. It frequently starts in the hands and feet but can affect other parts of the body too.
Neuropathy is very common. It is estimated that up to 30% of Americans will be affected by neuropathy. Although it affects people of all ages, older people are at increased risk. Almost 10% of adults over age 65 report some degree of neuropathy.
Common risk factors for neuropathy include diabetes, metabolic syndrome, and heavy alcohol use. People in certain professions, such as those that involve repetitive motions, have a greater chance of developing some form of neuropathy from trauma or compression of nerves. In many cases, a cause for the neuropathy cannot be identified; this is termed "idiopathic neuropathy."
Symptoms of neuropathy vary depending on the type and location of the nerves involved. Symptoms can be chronic or acute. Common signs and symptoms include tingling, a feeling of "pins-and-needles," or numbness, especially in the hands and feet. The pain can be described as sharp, burning, throbbing, stabbing or electric-like. Symptoms do not necessarily get worse with activity. There can be changes in sensation, and pain can be worse at night. You may experience loss of coordination, loss of feeling in your feet and hands, muscle weakness, or difficulty walking or moving your arms and legs.
Your foot and ankle orthopaedic surgeon diagnoses neuropathy from a thorough history and physical exam. During the exam, your surgeon may assess your reflexes, coordination/balance, muscle strength and tone, and sensation. Additional blood work and imaging tests may be ordered. Your surgeon may send you to a nerve specialist and may order a nerve conduction study (NCV) or needle electromyography (EMG) to evaluate how well the nerves are working This procedure involves placing small needles into your legs to test the nerves.
There are a variety of treatments for neuropathy, including medication, therapy, and surgery in some cases. Treatment starts with identifying and treating the underlying medical problem, such as diabetes or vitamin deficiency. There are certain medications that can help control pain by adjusting pain signaling pathways between the brain and the nerves. Talk to your doctor for more information.
Physical therapy can utilize a combination of exercise and other treatments to help you increase strength, range of motion, and balance. Occupational therapy can also help cope you with pain and loss of function. Mechanical aids such as braces, splints, and shoes can help reduce pain by providing support. Proper nutrition can ensure a right balance of vitamins and nutrients.
Surgery may be recommended for compression-related neuropathy such as a herniated disc in the back or neck, or nerve entrapment disorders, as seen in carpal tunnel syndrome.
Since patients with neuropathy often cannot feel when they have been hurt, minor injuries can lead to potentially catastrophic complications, such as ulcers, infection, and changes in the shape of your foot. There are several things you can do to protect yourself and avoid complications:
If you have diabetes, it is important to keep your blood glucose level within the recommended range.
Check your feet daily, and look for changes such as sores, blisters, redness, calluses, or dry/cracking skin. Moisturizing your skin is helpful to avoid cracks that could lead to an infection. Make an appointment with your foot and ankle orthopaedic surgeon if you have concerns.
Protect your feet from heat or cold and avoid walking barefoot.
Maintain a healthy lifestyle and eat a balanced diet.
Original article by Andrew Pao, MD
Contributors/Reviewers: Sudheer Reddy, MD
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