Peripheral neuropathy

Also called Nerve damage, Diabetic neuropathy

Damage to the nerves outside the brain and spinal cord. Numb feet are more dangerous than painful ones.

What it is

Peripheral neuropathy affects around 1 in 10 people over 55. Diabetes is the commonest cause in the UK; others include B12 deficiency, alcohol, chemotherapy, kidney disease, and a long list of less common conditions.

It usually starts in the longest nerves, so the feet go first, and it progresses upward in a glove-and-stocking pattern.

The counterintuitive point worth making early: painful neuropathy is miserable, and numb neuropathy is more dangerous. A foot that cannot feel a stone in a shoe, a hot bath or a blister is a foot that ulcerates, and that is the pathway to amputation in diabetes.

Signs you might notice

Numbness, tingling or a pins-and-needles sensation in the feet, then the hands.

Burning, shooting or electric pain, often worse at night.

Loss of sensation, so injuries go unnoticed.

Weakness, and difficulty with balance, particularly in the dark when vision cannot compensate.

Loss of the ankle reflex, which is why doctors tap ankles.

Autonomic involvement: dizziness on standing, digestive problems, bladder problems.

How it can affect day-to-day life

Foot ulceration is the outcome that matters most, and it is very largely preventable with daily checks and correct footwear.

Falls risk rises substantially, because balance depends on feeling the ground.

Night-time pain wrecks sleep, and ordinary painkillers do not work. Nerve pain agents such as amitriptyline, duloxetine, gabapentin or pregabalin are the treatments, and many people are never offered them.

Finding the cause matters. Some causes, such as vitamin B12 deficiency, are reversible.

Supporting someone well

Check feet every single day, and get somebody else to do it if you cannot see or reach. Look between the toes.

Never use hot water bottles or radiators to warm numb feet. Burns from this are common and severe.

Wear well-fitting footwear, and shake shoes out before putting them on.

Get any break in the skin seen the same day if there is diabetes.

Ask for the cause to be investigated: B12, thyroid, glucose, kidney function, alcohol history.

Ask for proper nerve pain treatment rather than paracetamol and codeine.

Manage falls risk: good lighting, and a walking aid if balance is affected.

Where to get help

A GP can investigate the cause and start treatment, and refer to neurology or podiatry.

For diabetes, ask for the annual foot check and for urgent podiatry access.

Any foot ulcer in diabetes needs specialist assessment within 24 hours.