Peripheral Neuropathy

Peripheral neuropathy is damage to the peripheral nerves — those outside the brain and spinal cord — causing numbness, tingling, weakness, or pain, most often affecting the feet and hands. It has many possible causes, with diabetes being one of the most common.

• Numbness or reduced sensation, often starting in the toes or feet and gradually extending upward
• Tingling or a "pins and needles" sensation
• Burning or shooting pain, which can be worse at night
• Muscle weakness in more advanced cases
• Increased risk of unnoticed injuries to the feet due to reduced sensation, which is a particular concern in diabetes

• Diabetes is one of the most common causes, particularly with long-standing or poorly controlled blood sugar.
• Other causes include vitamin deficiencies (particularly B12), excessive alcohol use, certain infections, some medicines, and, less commonly, inherited conditions.
• In some cases, despite thorough evaluation, no specific cause is identified.

• Diagnosed through a detailed history and examination, testing sensation, reflexes, and muscle strength in the affected areas.
• Blood tests help identify or exclude common causes, such as diabetes or vitamin B12 deficiency.
• Nerve conduction studies, where available, can help confirm the diagnosis and characterise the type and extent of nerve damage in less clear cases.

Treating the underlying cause is the most important step where one is identified — for example, optimising blood sugar control in diabetes, or correcting a vitamin B12 deficiency.

Pain relief for neuropathic pain often requires specific medicines rather than standard painkillers, as nerve pain responds differently, and treatment is usually started at a low dose and gradually increased.

Foot care is particularly important for people with peripheral neuropathy affecting the feet, given the increased risk of unnoticed injuries and, in diabetes, poor wound healing.

Physiotherapy can help with muscle weakness and maintaining function, and referral to a specialist is considered for progressive symptoms or an unclear cause.

• Maintain good blood sugar control if living with diabetes, which reduces the risk and progression of diabetic neuropathy.
• Limit alcohol intake, which can contribute to nerve damage.
• Check the feet regularly for injuries, particularly if sensation is reduced, since injuries may go unnoticed.
• Ensure adequate vitamin B12 intake, and seek assessment for known risk factors for deficiency.
• Seek medical assessment for new numbness, tingling, or pain in the hands or feet to identify and address the underlying cause.