How to Know if You Have Neuropathy in Your Feet

Three Parts:Recognizing Early SymptomsRecognizing Advanced SymptomsSeeing a Medical Professional for Confirmation

Foot neuropathy indicates some kind of a problem or malfunction with the small nerve fibers of the feet. Symptoms of neuropathy include pain (burning, electric and/or shooting in nature), tingling, numbness and/or muscle weakness in the feet.[1] Quite often, peripheral neuropathy affects both feet, but not always, as it depends on the cause. Common causes of foot neuropathy include uncontrolled diabetes, advanced alcoholism, infection, vitamin deficiency, kidney disease, foot tumors, trauma, drug overdose and exposure to certain poisons[2] Recognizing the signs and symptoms of foot neuropathy will certainly give you a better idea of what's causing your foot problem, but only a qualified health professional can let you know for sure.

Part 1
Recognizing Early Symptoms

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    Pay more attention to your feet. You might assume that some loss of sensation or sporadic tingling in your feet is a normal and expected part of aging, but it's not. Instead, it's an early sign that the small sensory nerves in your feet aren't working properly.[3] As such, examine your feet more often and compare the ability to feel light touch there with other parts of your body, such as your thighs or hands.
    • Use a pencil or pen to lightly stroke your feet (top and bottom) to see if you can feel it — better yet, close your eyes and ask a friend to do it.
    • Loss of sensation/vibration usually begins in the toes and slowly spreads up the foot and eventually the leg.
    • In the U.S., the most common cause of foot neuropathy is diabetes — 60–70% of diabetics will develop neuropathy within their lifetimes.[4]
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    Reconsider the foot pain you feel. Some occasional foot discomfort or cramping may be completely normal, especially after long walks in new shoes, but constant burning pain or strange intermittent electric pain without reason is an early sign of foot neuropathy.[5]
    • See if changing your shoes makes a difference with your foot pain, or try some off-the-shelf shoe inserts.
    • Neuropathic pain usually gets worse at night.[6]
    • Sometimes pain receptors get so sensitized with neuropathy that covering your feet with a blanket is unbearable — a condition known as allodynia.
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    Notice if your foot muscles feel weak. If walking is becoming more difficult or you seem more clumsy / accident prone while on your feet, then that may be a sign of early motor nerve damage due to neuropathy.[7] Foot drop while walking (leading to lots of stumbling) and loss of balance are also common neuropathic symptoms.
    • Try standing on your tip toes for 10 seconds and see how difficult that is — if you can't do it, then that may indicate a problem.
    • You may also notice involuntary twitching and loss of muscle tone in your feet.[8]
    • A cerebral stroke can also cause muscle weakness, paralysis and loss of sensation in your feet, but symptoms are usually sudden in onset and accompanied by several other signs and symptoms, whereas neuropathy is usually gradual.[9]

Part 2
Recognizing Advanced Symptoms

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    Take note of skin and toenail changes. Advanced damage to autonomic nerves in your feet will likely cause you to sweat less, so there will be less moisture in the skin (which become dry, scaly and/or flaky) and toenails (which become brittle).[10] You may notice your toenails start to crumble and look similar to a fungal infection.
    • If there is concomitant arterial disease caused by diabetes, lower leg skin can turn dark brown due to lack of blood flow.
    • In addition to color changes, the texture of the skin may change, often looking smoother and shinier than before.
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    Look for ulcer formation. Ulceration of the skin on the feet is a consequence of advanced sensory nerve damage. Initially, neuropathic ulcers can be painful, but as sensory nerve damage progresses, the ability of the nerves to transmit pain is dramatically reduced.[11] Repeated injury can result in multiple ulcer formation that you may not even notice.
    • Neuropathic ulcers usually develop on the bottoms of feet, especially in those who constantly walk around barefoot.
    • The presence of ulcers increases the risk of infection and gangrene (tissue death).
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    Beware of complete lack of sensation. Completely losing all sensation in your feet is a very dire situation and never considered normal. Not being able to feel the sensations of touch, vibration or pain makes it difficult to walk and puts you in danger of foot trauma leading to infection.[12] In advanced stages of the disease, the muscles of the feet may become paralyzed, making walking without assistance nearly impossible.
    • Loss of pain and temperature sensation may lead to carelessness about accidental burns and cuts. You may be unaware that you're injuring your feet.
    • Complete lack of coordination and balance puts you at risk for leg, hip and pelvis fractures due to falling.

Part 3
Seeing a Medical Professional for Confirmation

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    See your family physician. If you suspect that your foot issue is more than just a minor sprain or strain and may be neuropathic, then see your doctor — she will give you a physical exam and ask questions about your history, diet and lifestyle. Your doctor will also likely take your blood and check for high glucose levels (a telltale sign of diabetes), certain vitamin levels and thyroid function.
    • You can also test your blood sugar levels at home with a store-bought testing device, but make sure you read the instructions carefully.
    • High levels of glucose in the blood are toxic and damaging to small nerves and blood vessels, as is too much ethanol from drinking alcoholic beverages.
    • B-vitamin deficiencies, especially B12 and folate, are another relatively common cause of neuropathy.[13]
    • Your doctor may also take a urine sample to see how well your kidneys are functioning.
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    Get a referral to a medical specialist. You may have to see a nerve specialist (neurologist) in order to get a confirmed diagnosis of neuropathy. The neurologist may order a nerve conduction study (NCS) and/or an electromyelography (EMG) to test the ability of the nerves in your feet and legs in transmitting electrical messages.[14] Damage can occur in the protective covering of a nerve (myelin sheath) or underneath in its axon.
    • NCS and EMG are not very helpful for diagnosing small fiber neuropathy, so either a skin biopsy or quantitative sudomotor axon reflex test (QSART) are sometimes used.
    • Skin biopsy can reveal problems with nerve fiber endings and it's easier and safer than a nerve biopsy as your skin is on the surface.
    • Your specialist may also perform a color Doppler test so he can see the condition of the blood vessels of your legs — to rule in or rule out venous insufficiency.
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    See a podiatrist. A podiatrist is a foot specialist who can give you another informed opinion about your foot issue. A podiatrist will examine your foot for any trauma that may have damaged any nerves or benign growths or tumors that are irritating / compressing nerves. A podiatrist can also prescribe custom made shoes or orthotics (shoe inserts) for your feet to increase comfort and protection.
    • A neuroma is a benign growth of nerve tissue often found between the third and fourth toes.[15]


  • Certain chemotherapy drugs are known to cause peripheral nerve damage, so ask your cancer doctor about the side effects of treatment.
  • Some heavy metals like lead, mercury, gold and arsenic can be deposited in peripheral nerves and cause destruction.
  • Excessive and chronic alcohol consumption can lead to deficiency of vitamins B1, B6, B9 and B12, which are important for nerve function.
  • On the other hand, an excess of supplemental vitamin B6 can sometimes be harmful for your nerves.
  • Lyme disease, shingles (varicella-zoster), herpes simplex, Epstein-Barr virus, cytomegalovirus, hepatitis C, leprosy, diphtheria and HIV are types of infections that can lead to peripheral neuropathy.


  • See your doctor immediately if you experience any of the following signs or symptoms: quickly escalating severe foot pain, high fever, black discolored toes, strong nauseating foot odor, any joint dislocations or bone fractures.

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Categories: Feet Knees and Legs