Peripheral neuropathy is a term used to describe a condition of the nerves in which abnormal signals of sensation are transmitted. These abnormal conduction signals within the nerves can feel like a sharp-shooting pain, a stabbing pain, a burning pain, a feeling of numbness or even sometimes a tingling sensation. There are some unfortunate instances where a cause of peripheral neuropathy cannot be identified. In these cases, the term idiopathic neuropathy is used. Before this term is used, it is vital to work through possible causes of peripheral neuropathy. If the underlying cause is identified, this helps direct treatment for the neuropathy.
One very common cause of peripheral neuropathy is uncontrolled Diabetes Mellitus. Elevated blood sugars over a period of time makes the environment in the body less friendly to nerves and damage occurs to the lining of the nerve, called myelin. There are people who come into the podiatry office for stabbing, shooting, tingling or burning pain in the feet and have a history of Diabetes in their family but have never been tested. For some of these people, it is the peripheral neuropathy that serves as their first recognized symptom of diabetes. Once a diagnosis of Diabetes has been made, the first line of treatment is to control the blood sugars, usually through oral medication or use of insulin. Because the elevated sugars are the root cause of peripheral neuropathy in these instances, correcting this can alleviate some of these symptoms. Beyond this, vitamin supplements help to nourish the nerves and there are other oral medications that can be used to decrease the painful symptoms of peripheral neuropathy.
Another cause of peripheral neuropathy that is sadly often overlooked is present or past heavy alcohol use. Excess consumption of alcohol can also alter the body's natural environment and damage nerves. Of course, in this instance, there is even heavier reliance on our patients offering this information so that treatment can be initiated. Depending on the level of neuropathy, treatments can be similar to that for patients with diabetic peripheral neuropathy - of course with the recommendation of decreased or discontinued use of alcohol. This is a difficult thing to do, but is essential to restoring nerve function that can still be restored, or at least to preserve what nerve function still exists.
In patients with a history of treatment for cancer, peripheral neuropathy can be caused from certain chemotherapy agents. Depending on the length of use of these drugs, some nerve function can be naturally restored once treatment has ended. This happens over the course of 6 - 12 months, but in some cases, there is residual damage that may not be reversed. Some of the same medications used to decrease the pain from neuropathy in Diabetes can be used for patients with chemotherapy-induced peripheral neuropathy.
A localized cause of peripheral neuropathy in the feet is nerve entrapment. Tarsal tunnel and neuromas are the two main sources of this. When the nerve is physically entrapped or under pressure, it will become damaged and can causing burning, tingling, shooting pain, or numbness. In this scenario, allowing the nerve more room can help to facilitate normal function. This can sometimes be achieved by accommodative padding (mainly in the case of neuromas). If conservative treatment to decrease mechanical forces on the nerves is not effective, a surgical release of the nerve may be required. In the instances of neuromas in the feet, these may need to be removed if excessive scar tissue predisposes a person to recurrence from a simple nerve release.
In peripheral neuropathy, there is generally an order in which symptoms occur. Typically, sensations of burning, tingling and shooting pains are the early symptoms. Numbness typically is the last symptom to present. Some people ask, "if my foot is numb, why does that matter? Then I won't feel pain anymore!" While this is true, it needs to be pointed out that pain is a gift. An odd message perhaps, but very very true. Pain serves to tell us that there is something wrong in our body. This can mean that a fracture has occured or a tendon has been torn - if we don't know that information, we won't seek treatment and get better and heal. In the soles of the feet, pain tells us when we are walking on a hot driveway, when the bath water is too hot, when there is a pebble in our shoe, or when we have a blister or a splinter. If nerve damage has extended to the point of numbness, we may walk on that hot driveway, that pebble or that blister until a sore has developed and progressed so far that infection and amputation plague our future.
If you are feeling weird sensations in your feet or ankles and aren't sure of the cause, call today and make an appointment with one of the doctors at Prairie Path Foot & Ankle Clinic!