A foot neuropathy can be deduced from some problems or malfunctions of the small nerve fibers. Symptoms include pain (burning, electric, or stabbing), tingling, numbness and / or muscle weakness in the foot. Peripheral neuropathy most often affects both feet, but not always, depending on the trigger. Common causes include uncontrolled diabetes, advanced alcoholism, infections, vitamin deficiencies, kidney problems, foot tumors, trauma, drug / medication overdose, and exposure to certain poisons. Recognizing the signs and symptoms of neuropathic foot will undoubtedly help you understand the cause, but only a qualified professional will be able to make a certain diagnosis.
Steps
Part 1 of 3: Recognizing Early Symptoms
Step 1. Pay close attention to your feet
You may think that a slight loss of sensation or sporadic episodes of tingling are normal situations, a consequence of advancing age, but this is not the case: they are actually the first signs that the small sensory nerves in the feet are not working in the appropriately. Therefore, you need to examine the lower extremities more often and compare their ability to perceive tactile sensation with that of other parts of the body, such as the thighs or hands.
- Use a pencil or pen to lightly tap your feet (top and bottom) to see if you have a tactile sensation - better yet, try closing your eyes and asking someone to do it for you.
- Generally the loss of sensation / sensation starts in the toes and slowly spreads down the foot, sometimes even up to the leg.
- In the United States, the leading cause of foot neuropathy is diabetes; about 60-70% of diabetics develop this complication sooner or later.
Step 2. Reconsider the type of pain you are experiencing
Some discomfort or occasional foot cramps are absolutely normal, especially after a long walk in new shoes, but if you experience constant burning pain or strange intermittent electrical pain for no apparent reason, this is an early sign of neuropathy.
- Find out if changing shoes or using commercial insoles changes the pain in any way.
- Neuropathic pain typically gets worse at night.
- Sometimes the pain receptors become so sensitive with neuropathy that even the pressure generated by a blanket on the lower extremities becomes intolerable; this problem is known as allodynia.
Step 3. Pay attention to muscle weakness
If you find that walking becomes more difficult or you feel more awkward and prone to minor accidents when standing, this could be an early symptom of motor nerve damage from neuropathy. Other common symptoms of this condition are foot drop when walking (which leads to frequent tripping) and loss of balance.
- Try to stay on your fingertips for 10 seconds and see if you have difficulty; if you are unable to hold the position, it could be an indicator of some problem.
- You may also notice involuntary spasms and a loss of muscle tone in your feet.
- Among the causes of muscle weakness is stroke, which can lead to paralysis and loss of sensation in the feet. However, in this case there is no atrophy of the muscles or burning pain, but the legs become stiff and it can be very difficult to bend them.
Part 2 of 3: Recognizing Late Symptoms
Step 1. Take note of the changes in your skin and nails
When the damage to the autonomic nerves of the feet is at an advanced stage, you probably sweat less, so there is less moisture on the skin (which starts to become dry, flaky and / or brittle) and on the nails (which become brittle). You may find that your nails begin to break and take on a similar appearance to those with fungal infections.
- If you also suffer from any arterial disease due to diabetes at the same time, the skin on your lower legs may turn brown due to impaired blood circulation.
- In addition to color, skin texture can also change; the skin often appears smoother and smoother than before.
Step 2. Pay attention to ulcer formation
If you notice any sores on the skin of your feet, it means that the damage to the sensory nerves has worsened. Neuropathic ulcers can be painful at first, but as nerve damage progresses, the nerve's ability to transmit pain is drastically reduced. Repeated injuries can generate multiple ulcerations without you realizing it.
- Neuropathic ulcers typically form on the bottom of the foot, especially in those who always walk barefoot.
- The presence of ulcers increases the risk of infections and gangrene (tissue death).
Step 3. Pay attention to the complete loss of sensation
If you no longer have the tactile sensation in your feet, know that the situation is very serious and you must never consider it normal. If you are unable to feel touch, vibration or pain, it can become very difficult to walk and risk trauma to your feet which can lead to infections. When the disease is advanced, paralysis of the muscles of the feet can develop, making it almost impossible to walk without someone's help.
- Loss of sensitivity to pain and temperature can reduce the alertness threshold for accidental burns or cuts. You may not even realize that you have injured your feet.
- The complete loss of coordination and balance can increase the chances of fractures in the legs, hips and pelvic area due to possible falls.
Part 3 of 3: Contact the Doctor to Confirm the Diagnosis
Step 1. Contact your family doctor
If you suspect that your foot problem is more than just a muscle sprain or tear and that it may be neuropathic in nature, see your doctor. He will perform a thorough examination and will want to know your medical history, the type of diet you follow and your lifestyle. It will also invite you to take blood tests to check if your glucose levels are high (a clear indicator of diabetes), to check the concentration of certain vitamins and thyroid function.
- You can also check your blood glucose at home by purchasing a specific device, but make sure you read the instructions for use carefully.
- Too high a blood glucose concentration is just as toxic to blood vessels and small nerves as excess ethanol caused by alcoholism.
- Another relatively common cause of neuropathy is a deficiency of B vitamins, especially B12 and folic acid.
- Your doctor may also decide to have a urinalysis to check that your kidneys are functioning properly.
Step 2. Get examined by a specialist
You should go to a neurologist (nervous system specialist) to get confirmation that it is neuropathy. Your doctor may have specific tests, such as nerve conduction speed and / or electromyography (EMG), to check the ability of the nerves in the feet and legs to transmit electrical signals. Sometimes damage can occur in the protective covering of nerves (myelin sheath) or under their axon.
- These tests are not very effective in diagnosing small fiber neuropathy, so skin biopsy or a quantitative sudomotor axonal reflex test (QSART) is more likely to be done.
- Skin biopsy can detect problems with nerve fiber endings and is an easier and safer test than a nerve biopsy, since the skin is on the surface.
- The neurologist may also undergo a color Doppler to observe the state of the blood vessels in the legs, in order to exclude or consider venous insufficiency.
Step 3. Go to the podiatrist
This doctor is a foot specialist and will be able to give you qualified advice regarding your problem. He will examine the feet for any trauma that may have damaged the nerves and for benign or cancerous growths that may irritate / compress the nerve endings. In addition, he can prescribe tailor-made and personalized footwear or insoles to improve comfort and protect the lower extremities.
A neuroma is a benign growth of nerve tissue that often forms between the third and fourth toes
Advice
- Some chemotherapy drugs are known to cause peripheral nerve damage, so talk to your oncologist about the side effects of treatment.
- Some heavy metals, such as lead, mercury, gold and arsenic, can deposit on peripheral nerves and cause their destruction.
- Chronic excessive alcohol consumption causes a deficiency in vitamins B1, B6, B9 and B12, which are important for nerve function.
- At the same time, however, taking too many vitamin B6 supplements can sometimes damage the nerves.
- Lyme disease, herpes zoster (shingles), herpes simplex, Epstein-Barr virus, cytomegalovirus, hepatitis C, leprosy, diphtheria, and HIV are types of infections which can lead to peripheral neuropathy.
