Symptoms of peripheral neuropathy typically begin in the longest nerves first, usually in the toes and feet. Symptoms can include numbness or altered sensations such as a bunched sock feeling under the toes.
Peripheral neuropathy is damage to the nerves in the legs and arms. Idiopathic means that the underlying cause of the nerve damage is unknown.
This condition can have significant symptoms, and some patients notice no symptoms at all. The Cleveland Clinic estimates that 25 to 30% of Americans will be affected by peripheral neuropathy. They estimate that 30 to 40% of cases of peripheral neuropathy are idiopathic in nature.
Symptoms of peripheral neuropathy typically begin in the longest nerves first, usually in the toes and feet. Symptoms can include numbness, tingling, pain and oversensitivity to touch. Strange altered sensations may be present. Patients can describe the feeling that they have a bunched sock under their toes when they are not wearing a sock. Others report it feels as if they are walking on leather, rocks or have something wrapped around their feet. Sometimes a stimulus that is not normally painful is perceived as painful, such as a sheet touching a foot.
Some people do not notice any symptoms at all. These patients do not notice that they have lost sensation in their feet as the loss has been so gradual that it seems normal. They have no abnormal or strange sensations in their feet, but may gradually lose balance or develop a painless sore on their foot that normally would be expected to be painful.
Peripheral neuropathy can lead to loss of balance, weakness, hammer toes and foot deformity. Peripheral neuropathy may require the use of a cane, a walker or foot braces if severe. Peripheral neuropathy typically worsens as a person ages.
Loss of sensation in the feet can be serious. A person can develop a sore on the foot that they do not feel even if it becomes severely infected. This can lead to amputation of toes, legs and, in rare cases, even to death.
The loss of balance associated with peripheral neuropathy is also very serious as this puts a person at higher risk of falls. Falls can have catastrophic consequences.
1). In order to diagnose a peripheral neuropathy as idiopathic, one must first evaluate for treatable causes of peripheral neuropathy. Evaluate for a demyelinating peripheral neuropathy, this is done by an EMG test. Also, do blood work that includes hemoglobin A-1 C to evaluate for pre-diabetes, a vitamin B12 blood test with the goal being greater than 400, a TSH to rule out hypothyroidism and a serum protein electrophoresis test. If the peripheral neuropathy is idiopathic, all of these lab tests will be normal.
2). Excessive alcohol can cause a peripheral neuropathy determination that this is a cause is based on patient history.
3). Monitoring feet for any sores or cuts is important,and vigilant care if a wound is discovered.
4). There are medications that can help neuropathic pain. These include Neurontin (Gabapentin), Lyrica (Pregabalin) and Cymbalta (Duloxetine). These medications only help with pain. They do not correct numbness or balance problems. These medications do not slow the progression of the neuropathy as we age. These medications also have risk of dizziness, which can increase fall risk even further.
5). Avoid excess vitamin B6 - Vitamin B6 doses greater than 100 mg per day are toxic to the nerves and actually cause nerve damage. Vitamin B6 is included in prescription medications such as Metanex (used for neuropathy) as well as vitamin tablets and supplements
6). Avoid falls - eliminate throw rugs, have a night light, use a cane or walker for safety. Most falls occur inside the home.
7). Avoid smoking and limit alcohol intake.
8). Laser treatment may help temporarily with pain, it does not fix numbness or cure neuropathy.
9). Supplements such as alpha lipoic acid are available, but uncertain to be of benefit.
10). Regular exercise such as walking improves circulation, helps control weight and helps maintain balance.
Idiopathic peripheral neuropathy is very frustrating when it is found in a patient who is otherwise healthy. Knowledge about the condition is important. Ruling out treatable causes of peripheral neuropathy is imperative. Knowing that peripheral neuropathy increases the risk of falls can lead a person to be more careful and help prevent a fall. Medication treatment can help with neuropathic pain symptoms, but at this time there is no cure for idiopathic peripheral neuropathy.
To schedule an appointment with Dr. Katharine Leppard,
please call her office at 719-575-1800.