Peripheral Neuropathy in the Feet: Symptoms, Risks and Daily Protection

Maybe your toes feel numb when you pull off your boots. Maybe your feet tingle or burn at night. Those feelings can be a sign of peripheral neuropathy, a kind of nerve damage that often shows up in the feet first.^1,2

Neuropathy matters for more than comfort. When your feet can't feel pain the way they should, a small cut or blister can go unnoticed and turn into a bigger problem.⁵ This guide explains what neuropathy is, what causes it, what to watch for, and simple habits that help protect your feet.

What Is Peripheral Neuropathy?

Your peripheral nerves carry signals between your brain and spinal cord and the rest of your body. Cleveland Clinic describes peripheral neuropathy as "any type of nerve damage outside of your brain and spinal cord."² MedlinePlus puts it simply: it means "one or more of these nerves don't work properly."¹

The NIDDK notes that this kind of nerve damage "typically affects the feet and legs and sometimes affects the hands and arms."³

What Causes It?

Diabetes is the most common cause.^1,2 MedlinePlus explains that high blood sugar over a long time can damage nerves.¹ The CDC says about half of all people with diabetes have some kind of nerve damage, and the feet and legs are affected most often.⁵

Diabetes isn't the only cause, though. MedlinePlus lists several others:¹

• Long-term, heavy alcohol use
• Low levels of vitamin B1, B6, B12 or other vitamins
• Chronic kidney disease
• An underactive thyroid gland
• Some medicines, including some that treat infections, cancer, seizures and high blood pressure
• Infections such as HIV/AIDS, shingles and hepatitis C
• Poisoning from substances such as glue, lead, mercury and solvents
• Certain inherited disorders

Cleveland Clinic adds autoimmune conditions to the list.² And sometimes, MedlinePlus notes, "no cause can be found."¹

What Does Neuropathy Feel Like?

Symptoms vary from person to person. MedlinePlus says tingling or burning may be an early sign, and that these feelings "often start in your toes and feet."¹ Common symptoms include:^2,3,4

• Numbness or reduced feeling in the feet
• Tingling, like "pins and needles"
• Burning, sharp or stabbing pain, sometimes described as feeling like an electric shock
• Pain from a light touch that normally wouldn't hurt
• Muscle weakness in the feet and lower legs, and trouble with balance
• Dry, cracked skin on the feet

Numbness can also make it harder to tell where your feet are moving, which can affect your balance.¹ Cleveland Clinic notes that balance problems raise the risk of falls.²

What Is "Loss of Protective Sensation"?

With diabetic neuropathy, damage to the nerves can lead to "a gradual loss of protective sensation in the skin and foot joints."⁷ In other words, your feet may stop warning you about minor injuries.

To check for it, a clinician may use a pressure test with a thin filament called a 10 g monofilament.⁷ The NIDDK recommends a thorough foot exam at least once a year that includes a check of the feeling and pulses in your feet.⁶

Why Is Neuropathy Risky for Your Feet?

The CDC puts it plainly: "If you don't feel pain in your feet, you may not notice a cut, blister, sore, or other problem."⁵ MedlinePlus adds that you "may not notice when you step on something sharp," and that numbness in the feet "can lead to skin sores that do not heal."¹ Cleveland Clinic also lists burns from not feeling pain.²

The American College of Foot and Ankle Surgeons explains that the loss of sensation makes a person "prone to developing skin ulcers (open sores) that can become infected and may not heal."⁴ The CDC notes that nerve damage combined with poor blood flow raises the risk of foot ulcers, and that an infected ulcer may lead to amputation if it isn't treated.⁵ The NIDDK says diabetes can make these wounds hard to heal and can raise the chance of infection.³

That's why catching small problems early matters so much. If you have diabetes, our page on diabetic foot care at Big Sky Foot & Ankle explains more.

How Can I Protect My Feet Every Day?

These habits come from the CDC, NIDDK, MedlinePlus and ACFAS:^1,4,5,6

• Check your feet every day for cuts, redness, swelling, sores, blisters, corns, calluses or changes to the skin or nails.⁵
• Never go barefoot. Wear shoes and socks or slippers, even indoors.^5,6
• Check inside your shoes before you put them on, to make sure the lining is smooth and free of pebbles.⁶
• Wear shoes that fit well.^4,5 The CDC suggests trying shoes on at the end of the day.⁵
• Test bath water before stepping in. The NIDDK suggests using a thermometer (90° to 95°F is safe) or your elbow, and washing in warm, not hot, water.⁶
• Dry your feet well and use lotion on the tops and bottoms, but not between your toes.⁵
• Skip heating pads and hot water bottles on your feet.⁶
• Trim toenails straight across and smooth sharp edges with a file.⁵ Learn more about ingrown toenails.
• Don't cut corns or calluses yourself or use over-the-counter corn removers.⁶

If you have diabetes, keeping your blood sugar, blood pressure and cholesterol near your goals can help keep nerve damage from getting worse, according to the NIDDK.³ Our post on understanding diabetic foot care covers more everyday tips.

When Should I See a Podiatrist?

MedlinePlus advises contacting your provider if you have symptoms of nerve damage, noting that "early treatment increases the chance of controlling symptoms."¹ Cleveland Clinic encourages people not to put off telling a provider about symptoms such as pain or tingling.²

Make an appointment if you notice:

• New numbness, tingling or burning in your feet^1,5
• A change in the shape of your foot, or changes in skin color⁵
• Thickened toenails or a fungal infection⁵
• A cut, blister or bruise that doesn't start to heal after a few days⁶

Regular checkups matter too, even when nothing hurts. StatPearls lists patient education, proper foot care, correct shoes and an annual foot exam among the ways to help prevent problems.⁷ Read more in our post on regular foot exams for diabetics.

If you find a wound, an open sore or signs of infection, don't wait for a routine visit. ACFAS advises seeing a foot and ankle surgeon right away if you notice cuts, redness, blisters or swelling.⁴ Call our office using the numbers above.

The Bottom Line

Peripheral neuropathy is nerve damage that often starts in the toes and feet. Diabetes is the most common cause, but it isn't the only one. The biggest risk is that you may not feel a small injury until it becomes a sore that won't heal. Check your feet every day, never go barefoot, wear shoes that fit, and get a foot exam at least once a year.

If your feet feel numb, tingly or burning, our podiatrists can take a look. Request an appointment and our team will follow up within one business day. You can also find your nearest office on our locations page.

This article is for general education and isn't a substitute for medical advice. Talk with a podiatrist or your doctor about your own symptoms.

Sources

1. Peripheral Neuropathy. MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine. medlineplus.gov
2. Peripheral Neuropathy. Cleveland Clinic. my.clevelandclinic.org
3. Peripheral Neuropathy. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). www.niddk.nih.gov
4. Diabetic Peripheral Neuropathy. American College of Foot and Ankle Surgeons (FootHealthFacts.org). www.foothealthfacts.org
5. Diabetes and Your Feet. Centers for Disease Control and Prevention (CDC). www.cdc.gov
6. Diabetes & Foot Problems. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). www.niddk.nih.gov
7. Bodman MA, Dreyer MA, Varacallo MA. Diabetic Peripheral Neuropathy. StatPearls, NCBI Bookshelf. www.ncbi.nlm.nih.gov