Peripheral Neuropathy

The most common type of neuropathy is peripheral neuropathy.  It affects the nerves in the hands, feet, legs, and arms. It generally starts in the feet, and it tends to start in both feet at once.

Symptoms

Look at the list below, make a note about any symptoms you have and share it with your doctor during your next office visit.

Tingling

  • My feet tingle.
  • I feel "pins and needles" in my feet.

Pain or Increased Sensitivity

  • I have burning, stabbing or shooting pains in my feet.
  • My feet are very sensitive to touch. For example, sometimes it hurts to have the bed covers touch my feet.
  • Sometimes I feel like I have socks or gloves on when I don't.
  • My feet hurt at night.
  • My feet and hands get very cold or very hot.

Numbness or Weakness

  • My feet are numb and feel dead.
  • I don't feel pain in my feet, even when I have blisters or injuries.
  • I can't feel my feet when I'm walking.
  • The muscles in my feet and legs are weak.
  • I'm unsteady when I stand or walk.
  • I have trouble feeling heat or cold in my feet or hands.

Other

  • It seems like the muscles and bones in my feet have changed shape.
  • I have open sores (also called ulcers) on my feet and legs. These sores heal very slowly.
Often the symptoms, especially those of burning or shooting pain, are worse at night. Eventually the painful symptoms stop but the person now has a chronic feeling of numbness or coldness in their feet.

Diagnosis

Foot Exams

Your health care provider should look at your feet at each office visit to check for injuries, sores, blisters or other problems. As a reminder, take off your shoes and socks when you're in the exam room.

Have a complete foot exam once a year. If you already have foot problems, have your feet checked more often. A complete foot exam includes a check of the skin on your feet, your foot muscles and bones, and your blood flow. Your provider will also check for numbness in your feet by touching your foot with a monofilament. It looks like a stiff piece of nylon fishing line or a bristle in a hairbrush.

Other ways to check your nerves include using a tuning fork. It may be touched to your foot to see if you can feel it moving.

Nerve Conduction Studies and Electromyography (EMG)

If the doctor thinks you might have nerve damage, you may have tests that look at how well the nerves in your arms and legs are working. Nerve conduction studies check the speed with which nerves send messages. An EMG checks how your nerves and muscles work together.

Treatment

While keeping blood glucose levels in goal range can prevent peripheral neuropathy and keep it from getting worse, there aren’t any treatments that can reverse nerve disease once it’s established. Once neuropathy is detected, the focus is on keeping the feet and legs healthy and on managing pain. To treat nerve damage, you will need to keep your blood glucose levels in your target range, manage your pain and protect your feet. Many people get depressed when they have nerve damage and may need medication for depression as well as counseling.

Medications

Medications to relieve pain and reduce burning, numbness and tingling are available. Some of these are known for their use in other conditions but they still seem to help those with nerve damage.

Speak with your doctor to find out what treatments are best for you.

Personal Story from The Type 1 Diabetes Self-Care Manual by Jamie Wood, MD and Anne Peters, MD

Type 1 Diabetes Self-Care Manual

Real Pain

My neuropathy has grown from my feet to my ankles to my calves. The pain has steadily been increasing over the year and has gotten to the point where it has changed my lifestyle. I work a good portion of the day from bed so I can keep my legs up. I have had to abandon my business traveling. 

Last night we met a fantastic artist, a fascinating older woman. She paints and writes plays. We were standing as we visited her. It was after walking around for over an hour. I told her we needed to go because my ankles were killing me and the bottom of my feet felt like they were burning up. 

It feels as if parts of me are slowly dying. The ankles are real pain. At times, they feel as though they are swollen although they don’t appear to be. One Sunday, I had a nice creative day sitting in my bar stool at the kitchen counter. That night when we got into bed, I looked at my feet and they were swollen. You could not see the veins or bones. My feet look like they belong to an alien creature. I spent all day Monday in bed and by Tuesday, the swelling had subsided. Since then I make sure I don’t sit too long or stand. I really don’t expect there to be any magic pill for me. But, on the off chance there is something, I’d gladly give it a try.

—Eric Lichtbach, 61, has been executive director of a family manufacturing company since he was 19.

  • Last Reviewed: June 7, 2013
  • Last Edited: December 7, 2018

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