What Are The Underlying Causes Of Peripheral Neuropathy?

I have peripheral neuropathy in my feet and legs. They are very uncomfortable at night when I am not wearing shoes. I have sharp pains here and there in my feet, especially toes. Is there any help or relief for such a condition?

A neuropathy refers to an abnormality or change in a nerve which interferes with the nerveĆ­s ability to properly conduct impulses, leading to various symptoms. Because you use the term peripheral neuropathy, referring to the peripheral nervous system (all nerves outside the brain and spinal cord), I assume your doctor has told you this is the cause of your problems.

There are many peripheral neuropathies ranging from those involving only a single nerve, such as the one going to the facial muscles — a Bell’s palsy — to one involving almost all the nerves in the body, including those to the stomach and intestines. Peripheral neuropathies involving the feet and toes are quite common, and unfortunately the causes are not well understood.

Such neuropathies often cause symptoms such as tingling, and the sensations of “pins and needles” and burning. Numbness may also be present, and if the nerves to muscles are involved, then weakness, cramping, small involuntary trembling of the muscles, and loss of muscle mass may occur.

Pain without one of the other symptoms is unusual in a peripheral neuropathy, and should cause your doctor to look for other non-neurological causes. The fact that you have only pain, and it is worse when not wearing shoes would make me consider a more local orthopedic cause.

The list of possible causes of a peripheral neuropathy is a long one. It includes diabetes, many drugs, various industrial chemicals, alcoholism, Lyme disease, various vitamin deficiencies, various metal poisonings (arsenic, lead, mercury), HIV infection, syphilis, and diphtheria. Although vitamin deficiencies, alcoholism, syphilis, and diphtheria accounted for most cases in the pre-antibiotic era, diabetes is probably the most common identifiable cause now. There is also an inherited form of the condition which may be more common than most doctors appreciate. The inherited form of peripheral neuropathy is usually not severe, does not progress rapidly, and does not produce debility such as inability to walk.

Treatment should be directed to the specific cause if one can be identified. Good foot care is important. Since heat often precipitates more pain, wearing sandals may help, and soaking the feet in cold water before bed may reduce nighttime pain. Amitriptyline is often given, especially for the burning, tingling sensations, and there are many other drugs which may be tried, although complete relief with drugs is not common.

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