|Peripheral Nerves of the Foot|
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- Compression from repetitive stress
- Inflammation of nerves or blood vessels
- Hereditary syndromes
- Unknown causes
- Diabetes — type 1 or type 2
- Lyme disease
- Rheumatoid arthritis
- Uremia from chronic kidney failure
- Autoimmune disorders
- Viral infections like hepatitis
- Carpal tunnel syndrome —nerve in the wrist
- Sciatica —nerve roots forming the sciatic nerve in the back of the legs as they exit the spine
- Organic solvents
- Carbon disulfide
- Diphtheria toxin
- Chemotherapeutic agents to treat cancer, such as vincristine, paclitaxel, and cisplatin
- Anti-HIV medications, such as didanosine and zalcitabine
- Anti- tuberculosis medications, such as isoniazid and ethambutol
- Other antimicrobial drugs such as dapsone, metronidazole , chloroquine, and chloramphenicol
- Psychiatric medications, such as lithium
- Other medications, such as amiodarone, aurothioglucose, phenytoin, thalidomide, colchicine, cimetidine, disulfiram, hydralazine, and high levels of vitamin B6
- Vitamin deficiencies, such as thiamin , B12 , and vitamin E deficiency
- A tumor pressing on a nerve
- Exposure to cold or radiation
- Acute or chronic demyelinating polyneuropathy
- Paraneoplatic syndromes
- Genetic disorders, such as Charcot-Marie-Tooth disease or hereditary motor and sensory neuropathy
- Prolonged treatment in the intensive care unit
- Alcohol abuse
- Autoimmune diseases, such as rheumatoid arthritis or celiac sprue
- Family member with peripheral neuropathy
- Exposure to toxins or medications known to cause neuropathy
- Vitamin deficiency, such as thiamin and vitamin B12
- HIV infection
- Pressure on a nerve—may occur with repetitive stress injuries
- Hospitalization treatment in the intensive care unit
- Numbness or reduced sensation
- Pain, often a burning or sharp, cutting sensation
- Sensitivity to touch
- Muscle twitches
- Muscle weakness
- Muscle cramping
- Difficulty with walking
- Loss of coordination or balance
- Loss of reflexes and muscle control
- Muscle atrophy—loss of muscle bulk
- Foot deformities
- Foot ulcers
- Injuries to the feet that go unnoticed and become infected
- Autonomic dysfunction—sweating, bowel and bladder dysfunction, cardiovascular effects
- Difficulty breathing
- Problems regulating blood pressure
- Erectile dysfunction
- Muscle strength
- Ability to feel vibration, temperature, and light touch
- Semmes-Weinstein monofilaments test—measures sensation in the feet using a fine flexible wire
- You may need to have tests of your bodily fluids and tissues. This can be done with:
- You may need to have your nerves and muscles tested. This can be done with:
- You may need to have pictures taken of your bodily structures. This can be done with:
- Your doctor may need to evaluate other family members for this condition.
Treatment for the Underlying Illness or Exposure
- Balance issues
- Muscle weakness
- According to the Food and Drug Administration (FDA), patients of Asian ancestry who have a certain gene, called HLA-B*1502, and take carbamazepine are at risk for dangerous or even fatal skin reactions. If you are of Asian descent, the FDA recommends that you get tested for this gene before taking carbamazepine. If you have been taking this medication for a few months with no skin reactions, then you are at low risk of developing these reactions. Talk to your doctor before stopping this medication.
- IV immunoglobulins
- Plasmapheresis —done to exchange plasma in the blood
- Manage chronic medical conditions with the help of your doctor. If you have diabetes, visit a podiatrist for yearly exams.
- Eat a healthful diet that is low in saturated fat and rich in whole grains, fruits, and vegetables.
- Be sure to get the right amounts of thiamin and vitamin B12.
- Limit your alcohol intake to a moderate level. This means two or fewer drinks per day for men and one or fewer for women.
- Toxic chemicals
- Repetitive movements
- Prolonged pressure on joints, especially elbows and knees
American Chronic Pain Association http://www.theacpa.org
The Neuropathy Association http://www.neuropathy.org
Canadian Diabetes Association http://www.diabetes.ca
Health Canada http://www.hc-sc.gc.ca
Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. 2010;9(8):807-819.
Diabetic neuropathies: the nerve damage of diabetes. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health website. Available at: http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/index.aspx . Updated June 25, 2012. Accessed February 21, 2013.
Dyck PJ, Thomas PK, Dyck PJ, Thomas PK, eds. Peripheral Neuropathy . 4th ed. Philadelphia, PA: Saunders; 2004.
Fermaglich J. Merritt's Neurology . 11th ed. Chicago, IL: Lippincott Williams & Wilkins; 2005.
Karlsson P, et al. Epidermal nerve fiber length density estimation using global spatial sampling in healthy subjects and neuropathy patients. J Neuropathol Exp Neurol . 2013 Mar;72(3):186-93.
Peripheral neuropathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated November 15, 2012. Accessed February 21, 2013.
Samuels MA, Feske SK. Office Practice of Neurology . Philadelphia, PA: Churchill Livingstone; 2003.
Williams O. Introduction to and clinical evaluation of peripheral neuropathies. In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corporation.
12/20/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : 2007 safety alerts for drugs, biologics, medical devices, and dietary supplements: Carbamazepine (marketed as Carbatrol, Equetro, Tegretol and generics). Medwatch. US Food and Drug Administration website. Available at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#carbamazepine .
10/5/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Feng Y, Schlösser FJ, Sumpio BE. The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy. J Vasc Surg. 2009;50:675-682,682.
- Reviewer: Rimas Lukas, MD
- Review Date: 03/2013 -
- Update Date: 00/31/2013 -