Peripheral Neuropathy

Peripheral neuropathy is a term used to describe damage to the peripheral nervous system, the vast network of nerves that come from the brain and spinal cord out to the arms, hands, legs, and feet.

Many symptoms can occur when peripheral nerves are damaged. There can be numbness, tingling, shooting sensations, sensitivity to touch, and muscle weakness.  In severe cases, some people experience a burning pain (especially at night), muscle wasting, sweat gland dysfunction, problems controlling blood pressure.

In chronic forms of neuropathy, symptoms begin subtly and progress slowly.  Some people may have periods of relief followed by relapse.  Most commonly, we see polyneuropathy which is characterized by symptoms occurring in both feet followed by a gradual progression up both legs.  This type of neuropathy is seen in people with diabetes.

Peripheral neuropathy may be either inherited or acquired.  Causes of acquired peripheral neuropathy include physical injury (trauma) to a nerve, toxins, nutritional deficiencies, alcoholism, and vascular and metabolic disorders such as peripheral arterial disease or diabetes.

Diagnosis of peripheral neuropathy can be difficult due to the various and often vague symptoms associated with the condition.  Often, a diagnosis is made based on these symptoms.  Blood work can be done to test for things like diabetes, vitamin deficiences, liver or kidney dysfunction or signs of abnormal immune function.  Other testing such as a CT scan, MRI or nerve conduction test may be performed if initial tests do not reveal a cause.

What we can do to help you manage this problem

If you are having symptoms consistent with peripheral neuropathy, we would recommend that we see you as a patient.  It is important to try to determine the cause of the condition to help guide proper treatment.

Initially, we will perform a complete history and physical examination of your feet to determine the cause of your symptoms.   A biomechanical examination may be performed to determine if gait may play a role in your pain.  We can recommend certain thing that can be helpful if you have neuropathy such as proper diet, exercise, smoking cessation, limiting alcohol and correcting vitamin inefficiencies.  It is also important to control any underlying systemic diseases such as diabetes.

We sometimes will perform a test in our office called an Epidermal Nerve Fiber Density skin biopsy.  This is a test in which we remove a small skin sample to examine nerve fiber endings.  This test can reveal damage present in the smaller fibers and is often predictive of peripheral neuropathy.  

Sometimes neuropathy is caused by poor foot biomechanics which places excessive strain onto the nerves of your feet.  In cases such as this, arch supports or custom orthotics can be helpful for realigning and supporting your foot structure.  We carry arch supports in our office that are typically much better than what you will find in the store.  Some cases of  peripheral neuropathy may require the use of a prescription orthotic.  This is a custom-made arch support that is made from a plaster impression or digital scan of your foot and arch. Unlike pre-made arch supports, however, an orthotic completely controls abnormal pronation or flattening of the arch and would most effectively remove strain from the nerves in your feet.  

 

Vitamin supplements like NeuRemedy and Mentanx can be helpful in the management of peripheral neuropathy.  We have seen good results with both of these supplements. NeuRemedy is only dispensed in physician offices (we carry it here) and Mentanx is by prescription only.  Both are very safe to take and will not interfere with other medications that you may be taking.

We have also had good luck using topical compounded creams to treat peripheral neuropathy. Compounded medications have the advantage of being able to combine multiple medications into one cream.  This way, we can customize the treatment to target your symptoms.  Topical creams are extremely safe and will not interfere with any other medications that you may be taking.

If your symptoms are severe, we sometimes use prescription medications to treat peripheral neuropathy. Most prescription medications work by calming the nerve impulses.  Medications such as Lyrica and Gabapentin can be effective for controlling the pain and burning associated with peripheral neuropathy, but can have side effects.

If you are having symptoms consistent with peripheral neuropathy, it is important that we see you to help determine the cause and to develop the proper course of treatment.  The doctors at Council Bluffs Foot & Ankle Care are experts in the treatment of this condition. Call to request an appointment today.

320 McKenzie Ave., Ste. 102

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