Peripheral neuropathy

What is peripheral neuropathy, and how common is it?

Peripheral neuropathy (nerve damage in the feet and other outer parts of the body) means damage to one or more of the nerves outside your brain and spinal cord¹. It most often affects the feet, legs, hands and arms, and can cause pain, weakness, numbness or tingling². Most people with neuropathy have polyneuropathy, which affects several nerves².

It affects about 1% of adults worldwide³. It's much more common in people with diabetes: estimates range from about a third to about half of people with diabetes⁴⁵. Diabetes-related nerve damage is the most common cause of neuropathy worldwide⁵.

What causes it, and who gets it?

Diabetes is the most common cause. Others include vitamin B12 deficiency, heavy alcohol intake over a long time, and some chemotherapy drugs¹. Kidney problems can also be involved⁶. For many people no cause is found: about 30% of people with the usual pattern of numbness starting in the feet have no cause identified⁶.

If you have type 2 diabetes, neuropathy is linked with having diabetes for longer, being older, higher HbA1c (a long-term blood sugar measure) and diabetic retinopathy (eye damage)⁵. Chronic kidney disease is linked with it too⁴. These are links, not proof of cause⁵.

If you have diabetes and neuropathy, other causes such as low B12, alcohol and thyroid problems can also play a part, so it's worth asking whether they've been checked⁷.

What does it feel like, and how is it diagnosed?

It usually starts in the feet, sometimes the hands. You may notice numbness, tingling, pins and needles, burning, stabbing or shooting pain, loss of balance and muscle weakness, especially in the feet⁸¹. Burning pain is often worse in bed at night¹. The longest nerves are affected first, so symptoms typically start in the toes and move up the leg³. Some people lose the ability to feel pain or temperature changes⁹. Weakness can make it hard to lift the front of the foot when walking, called foot drop¹⁰.

A doctor or podiatrist usually starts with your story and an examination, and blood tests can sometimes find a further cause⁶. If you have diabetes, your feet should be screened for loss of protective sensation (the feeling that warns you of harm) and for poor circulation at least once a year, and more often if your risk is higher¹¹.

What helps first?

When feeling is reduced, protecting your feet is the main step. If you have diabetes, learn how to care for your feet, avoid walking without suitable foot protection, and have any early skin damage on the foot treated¹¹. Wear sensible, supportive shoes or boots, and any prescribed insoles as much as you can⁹. Check your feet regularly, because an untreated injury can become infected⁹. People with diabetes should also have regular foot checks by a podiatrist¹².

If nerve pain is troubling you, ask your doctor or a pharmacist about options. Medicine choices are best made with your doctor.

What helps if that isn't enough?

If your symptoms aren't settling, go back to your doctor to review the cause and your options, and ask whether a referral would help. Keep up your foot protection and daily checks in the meantime.

If your symptoms started during chemotherapy, speak to your doctor. They may consider delaying, reducing, substituting or stopping treatment¹³¹⁴. Please don't change your cancer treatment yourself.

What's the outlook, and what helps prevent problems?

It isn't clear yet how much feeling is likely to return, so ask your doctor what to expect for your cause. In people with type 2 diabetes, blood sugar control and kidney health were linked with developing new neuropathy, so looking after both may help¹⁵. Your diabetes team can advise.

Lost feeling means injuries, burns and infections can go unnoticed, and infection is more common and more serious with diabetes¹. Balance problems also raise the risk of falls: people with diabetes and neuropathy are more likely to fall than those without it¹⁶. Nerve changes can be gradual and unnoticed, so have your feet screened and assessed at least once a year by your GP, practice nurse or podiatrist⁹.