Peripheral Neuropathy: Symptoms, Causes and Treatment
Peripheral neuropathy is damage to the peripheral nerves that carry sensation and movement signals between the spinal cord and the body. Diabetes is the most common cause [3], but there are many others [1].
Symptoms
- Numbness, tingling or burning, often starting in the feet
- Pain, sometimes worse at night
- Loss of balance, especially in the dark
- Weakness of the feet or hands
- Foot ulcers that heal poorly in severe cases
Further reading: the guide “Neurological Diseases” and the articles Rehabilitation in Multiple Sclerosis and Physiotherapy and Rehabilitation in Parkinson’s Disease.
Causes
- Diabetes
- Vitamin B12 deficiency, alcohol, thyroid and kidney disease
- Certain medicines, including some cancer treatments
- Autoimmune and inflammatory conditions, including Guillain-Barré syndrome
- Inherited neuropathies
Diagnosis
Diagnosis is based on examination, blood tests and electrodiagnostic testing (nerve conduction studies and EMG), which show which nerves are affected and how [1].
Treatment
Treating the cause is essential, for example good glucose control in diabetes [3]. For neuropathic pain, medicines such as pregabalin, gabapentin, duloxetine and tricyclic antidepressants are used, chosen individually [2]. Physiotherapy for balance and strength, foot care and fall prevention complete the treatment.
Understanding the nerves involved
Peripheral nerves carry three kinds of signals. Sensory fibres carry touch, temperature, pain and position sense (the feeling of where the feet and hands are without looking). Motor fibres make muscles contract. Autonomic fibres regulate functions such as sweating, blood pressure, bladder and bowel. Most neuropathies begin in the longest nerves, so symptoms usually start in the toes and feet and later involve the hands, a pattern described as “stocking-glove”. Some neuropathies affect a single nerve (mononeuropathy), such as carpal tunnel syndrome.
Typical course
The course depends on the cause. Neuropathy related to diabetes or long-term alcohol use usually progresses slowly over years; it can stabilise when the cause is controlled. Neuropathy caused by vitamin B12 deficiency, certain medications or toxins may improve after the cause is corrected, although nerve recovery is slow, often months, because nerves regrow by roughly a millimetre a day. Inflammatory neuropathies can develop over days to weeks and need prompt specialist assessment.
Rehabilitation assessment
In addition to diagnostic tests, your physical medicine and rehabilitation (PM&R) specialist assesses strength, sensation, reflexes, balance with eyes open and closed, walking pattern, foot position, skin condition, pain and how symptoms affect work and daily life. Fall risk is an important part of this assessment, because reduced position sense makes balance much harder, especially in the dark.
Rehabilitation and support treatments in general terms
- Balance and gait training to improve stability and reduce falls.
- Strengthening exercises for weak muscles, such as the ankle and foot lifters.
- Orthoses (supportive braces), for example an ankle-foot orthosis for foot drop, and appropriate footwear or insoles.
- Pain management, which may include medication for nerve pain, physical modalities and education about pacing activities.
- Occupational therapy and aids for fine hand tasks when the hands are affected.
- Treatment of the underlying cause in cooperation with other specialists, for example optimising blood-sugar control.
The exercise programme is planned by your physical medicine and rehabilitation specialist and the physiotherapist and adjusted as symptoms change.
Foot care and home safety: what you and your family can do
- Inspect the feet every day for cuts, blisters or redness; use a mirror or ask a family member if needed.
- Check bath water temperature with the elbow or a thermometer, not with the feet.
- Wear well-fitting, closed shoes; avoid walking barefoot.
- Keep good lighting at night, remove loose rugs and install grab rails in the bathroom.
- Stand up slowly if dizziness occurs on standing, which can be an autonomic symptom.
- Stay active; regular walking or cycling within your limits supports strength and balance.
When to consult your PM&R specialist
Seek review if weakness or numbness is spreading, if you have falls or near-falls, foot drop, a foot wound that does not heal, burning pain that disturbs sleep, or new bladder or blood-pressure symptoms. Rapidly progressing weakness over days requires urgent medical assessment. For ongoing care, consult a PM&R specialist, who can guide therapy and support treatments.
Frequently asked questions
Can neuropathy be cured? It depends on the cause. Progression can often be slowed and symptoms reduced.
Why is EMG needed? It confirms the diagnosis and distinguishes neuropathy from other conditions with similar symptoms. See Guillain-Barré syndrome recovery.
Can exercise help neuropathy? Exercise does not repair nerves directly, but balance, strength and endurance training can improve stability, walking and confidence, and may help with pain.
Why are my symptoms worse at night? Nerve pain often feels stronger at rest when there are fewer distractions. Good sleep routines and treatment planned by your doctor can help.
Assessment and contact
You can request an appointment or a second-opinion review of existing reports and imaging: Contact & second opinion (WhatsApp). This page is general health information. Diagnosis and treatment decisions are made individually after examination.
Sources
- Mauermann ML, et al. Peripheral Neuropathy: A Review. JAMA. 2026. PMID: 41247746
- Finnerup NB, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015. PMID: 25575710
- Pop-Busui R, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017. PMID: 27999003