- Peripheral neuropathy is nerve damage that most commonly affects the feet and lower legs, causing burning, tingling, numbness, or loss of sensation.
- Diabetes is the single most common cause, but neuropathy also occurs from medications, vitamin deficiencies, autoimmune disease, alcohol use, and other systemic conditions.
- Loss of sensation is the most dangerous symptom — patients can develop unnoticed wounds that progress to ulcers and infection.
- Treatment focuses on identifying and managing the underlying cause, controlling symptoms, and protecting the foot from injury.
- Regular podiatry visits are the foundation of long-term care — even when there's no pain, your feet still need monitoring.
What is peripheral neuropathy?
Peripheral neuropathy is damage to the nerves outside the brain and spinal cord — the ones that carry signals to and from your hands, feet, and internal organs. When those nerves don't work properly, you may feel burning, tingling, or "pins and needles." More worryingly, you may stop feeling things you should — a sharp pebble in your shoe, a small blister, a hot bath.
The feet are usually affected first because the nerves running to them are the longest in the body and the most vulnerable. Diabetes is by far the most common cause, but neuropathy also shows up with prediabetes, vitamin B12 deficiency, chemotherapy, certain antibiotics, alcohol use, autoimmune diseases, kidney disease, hypothyroidism, and physical nerve trauma. Sometimes no specific cause is identified (idiopathic neuropathy).
At Northwest Extremity Specialists, neuropathy evaluation focuses on three things: confirming the diagnosis, identifying the underlying cause when possible (often in coordination with your primary care provider or endocrinologist), and protecting your feet from the complications that loss of sensation causes — ulcers, infection, and Charcot foot.
See it in motion
Animations licensed from ViewMedica · Swarm Interactive
Peripheral nerves come in three functional types. Sensory nerves carry information about touch, temperature, pain, and vibration. Motor nerves tell muscles to contract. Autonomic nerves control unconscious functions like sweating, blood-vessel tone, and blood pressure. Neuropathy can affect any or all three types — which is why one patient may have only numbness, another may have weakness or balance trouble, and a third may have problems with sweating or blood pressure regulation.
What it feels like
Neuropathy symptoms vary by which type of nerve is affected. Common patterns:
- Burning, tingling, prickling, or "electric" sensations in the feet, often worse at night
- Numbness or loss of sensation — sometimes patients say their feet feel "like wood" or "like there are socks on" when there are none
- Sharp, shooting, or shock-like pains
- Extreme sensitivity to touch — even bedsheets can feel painful
- Muscle weakness in the feet or lower legs
- Loss of balance or coordination, especially in the dark
- Frequent falls or stumbling
- A foot wound or ulcer that you didn't notice happening (a red flag)
- Changes in skin color, temperature, or sweating in the feet (autonomic involvement)
Why it develops
Neuropathy has many causes. Identifying yours is part of treatment:
- Diabetes and prediabetes — the most common cause by far
- Vitamin B12 deficiency (especially in older adults, vegetarians, and patients on long-term acid-reducers)
- Heavy alcohol use
- Chemotherapy and certain other medications
- Autoimmune diseases (lupus, rheumatoid arthritis, Sjögren's, Guillain-Barré)
- Hypothyroidism, kidney disease, liver disease
- Physical nerve trauma (compression, prior surgery, repetitive injury)
- Inherited neuropathies (Charcot-Marie-Tooth)
- Some infections (Lyme, shingles, HIV)
- Idiopathic — no identified cause despite workup
How we diagnose peripheral neuropathy
A neuropathy evaluation starts with a focused history (when the symptoms started, what they feel like, which medications and conditions are in play) and a careful physical exam — checking pulses, skin integrity, reflexes, and sensation to light touch, vibration, and pinprick. The classic in-office monofilament test screens for protective sensation loss. When needed, we coordinate blood work (A1c, B12, thyroid, metabolic panel) and refer for nerve conduction studies or to a neurologist. Most patients leave the first visit with a working diagnosis, a protection plan for their feet, and any necessary lab orders.
Non-surgical care
Neuropathy treatment has two equally important goals: control the symptoms, and prevent the complications. Our standard plan combines:
- Address the underlying cause — tight blood-sugar control for diabetic neuropathy, vitamin replacement, medication review, alcohol reduction
- Symptom-targeted medications (gabapentin, pregabalin, duloxetine, topical agents) prescribed or recommended in coordination with your primary care team
- Custom orthotics or diabetic shoes to redistribute pressure and prevent ulcers
- A daily foot-check routine that we teach you — looking for blisters, cuts, redness, or swelling you may not feel
- Regular podiatry follow-ups (every 2–3 months for higher-risk patients) for nail and callus care and skin checks
- Physical therapy for balance training in patients with falls risk
When to see a specialist
- New burning, tingling, or numbness in your feet — even mild
- Any unexplained foot wound, sore, or ulcer, especially if you have diabetes
- Diabetes plus you haven't had a foot exam in the past year
- Recurring falls or new balance trouble
- A change in foot shape, redness, or warmth (could be Charcot foot — urgent)
- Pain that's waking you at night or limiting your daily activity
Neuropathy evaluation and ongoing foot protection is provided by all of our board-certified podiatrists. Dr. Cara Beach at Cedar Mill and Hoyt sees a high volume of diabetic and neuropathic patients and runs a structured surveillance program for high-risk feet. When neurology workup or systemic disease management is needed, we coordinate directly with your primary care provider or endocrinologist.