Overview
Peripheral neuropathy is a problem with the nerves outside the brain and spinal cord, most often affecting the feet and sometimes the hands. When nerves are damaged or irritated, they may send incorrect signals, which can cause numbness, tingling, burning pain, or weakness. Over time, sensory changes can also affect balance and walking safety. Many cases are treatable when the underlying cause is identified early.
Symptoms
People with peripheral neuropathy commonly notice numbness, tingling, or a burning or electric pain in the feet, often starting in the toes and gradually moving upward. Symptoms may be worse at night or when the feet are at rest, and some people also experience increased sensitivity to touch, even from light contact like sheets. As sensation and strength decline, walking may feel less steady, and small injuries can go unnoticed. In more advanced cases, weakness or reduced reflexes can contribute to foot problems and balance difficulties.
Causes
Peripheral neuropathy can develop when nerve fibers are injured or function is impaired by metabolic problems, toxins, inflammation, or compression. Common causes include diabetes or prediabetes, vitamin B12 deficiency, heavy alcohol use, kidney disease, infections, autoimmune conditions, and side effects of certain medications such as chemotherapy. Less commonly, it can be hereditary, or it may result from a focal nerve entrapment that presents as a neuropathy pattern.
Risk Factors
Risk increases with conditions that affect blood vessels and nerve health, especially diabetes or prediabetes, and with age-related nerve vulnerability. Alcohol misuse, poor nutrition leading to vitamin deficiencies (particularly B12), chronic kidney disease, and exposure to certain medications can also raise risk. A personal or family history of neuropathy, autoimmune disease, and smoking can contribute as well.
Prevention
You can reduce risk by controlling blood sugar if you have prediabetes or diabetes and by limiting alcohol intake. Maintaining a balanced diet that supports adequate vitamin levels, especially B12, and staying physically active can help support nerve health. For foot safety, wear well-fitting protective footwear, check feet daily for minor injuries, and avoid repetitive pressure or tight footwear that can worsen nerve irritation.
How the Diagnosis Is Evaluated
Clinicians usually start with a detailed history of symptom timing, distribution (for example, toes first), triggers, and any underlying medical conditions or medication exposures. A neurologic examination assesses sensation (such as light touch, vibration, and temperature), reflexes, muscle strength, and balance or gait. Depending on the situation, blood tests may be ordered to look for treatable causes, and nerve conduction studies and electromyography (EMG/NCS) are often used to confirm the type and severity of neuropathy. Imaging or specialized tests such as skin biopsy for small fiber neuropathy may be considered in selected cases.
Nonsurgical Treatment Options
Treatment focuses on the underlying cause when possible, such as improving blood sugar control, correcting vitamin deficiencies, reducing alcohol exposure, or adjusting medicines that may contribute to neuropathy. For symptom relief, clinicians may recommend neuropathic pain medications like duloxetine or gabapentinoids, and some patients benefit from topical therapies such as lidocaine or capsaicin. Physical therapy and a home exercise program can improve strength, flexibility, and balance, which helps reduce fall risk and improves walking confidence. Supportive measures are often important, including appropriate shoes, orthotics, and sometimes assistive devices to protect insensitive areas of the foot. If the neuropathy is related to a focal nerve entrapment, a clinician may consider a targeted corticosteroid injection around the compressed nerve along with splinting or activity modification.
When to Seek Medical Attention
Seek medical attention promptly if symptoms are rapidly worsening, if you develop significant weakness, or if you cannot walk safely due to sensory loss or balance problems. Go urgently (or emergency care) if neuropathy comes with red-flag neurologic symptoms such as bowel or bladder changes, saddle numbness, severe back pain with new neurologic deficits, fever with rapidly progressive symptoms, or sudden loss of function. Also seek evaluation soon if you notice foot ulcers, infection, or injuries that are not improving, especially in people with diabetes.
Frequently Asked Questions
It often feels like numbness, tingling, burning, or shooting pain in the feet, sometimes worse at night.
Doctors typically use a neurologic exam and may add blood tests, EMG/NCS, and other targeted tests depending on the suspected cause.
Next Steps
If you suspect peripheral neuropathy, schedule a clinical evaluation so the cause can be identified and treated while symptoms are still manageable. Be ready to share your medical history, medication list, and a description of where symptoms start and whether they are getting worse. If you have rapid progression, severe weakness, or bowel or bladder changes, seek urgent care immediately.