Peripheral Neuropathy

Ever wonder where that tingling, shooting, burning, even cramping type of pain shooting down your legs or even localized in your feet come from?

Peripheral neuropathy is estimated to affect well over 3 million people in the United States, primarily affecting those over the range of 41 years.

As common as this condition is and as many causes as there could be peripheral neuropathy is a condition that tends to be progressive and gets worse if not properly treated and diagnosed in a timely fashion.

Peripheral neuropathy is not completely understood, however, what we do know is that there are several causes of peripheral neuropathy.

1-Nerve Entrapment

2-Biomechanical

3-Metabolic/Nutritional

4-Systemic Disease

5-Side Effects of Medications

6-Toxins

7-Trauma

7-Idiopathic (Unknown)

Nerves are highly complex intricate and very delicate tissue that resembles a finely specialized wire that conducts biochemical and electrical impulses. For today’s article, we will discuss the first three underlying causes of peripheral neuropathy.

Peripheral nerve entrapment occurs most frequently when tissue either arthritic bone in the lower back for example or dense thickened scar tissue strangulates and compresses a nerve in such a way to where it is no longer mobile and frequently impinges the nerve and constricts it resulting in peripheral neuropathic symptoms. Sometimes this scar tissue can form as a result of acute or chronic repetitive trauma, or it can be due to a space-occupying lesion such as bulging varicose vein‘s, or as a result of soft tissue accumulation from systemic diseases such as sarcoidosis, amyloidosis, and even rheumatoid arthritis for example.

Frequently nerve conduction velocities and electromyograms can be ordered and performed by a specialized neurologist and can determine how nerves are functioning and how they’re related to the muscles that they innervate. By using this information one can determine local areas of nerve entrapment, which after extensive study and even sequential testing such as a musculoskeletal ultrasound or an MRI can reveal locations where scar tissue is impinging down a nerve. These areas can potentially be released surgically in a procedure known as external neurolysis. If non-surgical treatment options are desired, they are also available. This entails taking medicines by mouth to treat nerve-like pain. Examples of such medicines include gabapentin, pregabalin, and duloxetine.

The second frequently encountered scenario, is biomechanical. This is due to a specific foot ankle or lower leg deformity that frequently will stress, strain, or stretch the nerve physiologically in such a way that causes tension on the nerve. This is comparable to yanking a wire and can produce neuropathic symptoms as well. For example, a severe flat foot deformity can put a severe strain on the posterior tibial nerve of the inner ankle and can cause symptoms known as tarsal tunnel syndrome.

In this scenario, oftentimes custom-made orthotics, foot bracing, taping, strapping, padding, stretching exercises, physical therapy modalities, including laser anodyne treatment, and anti-inflammatory medicines can be used to help relieve some of the tension of a biomechanically strained nerve. These devices can be frequently ordered and prescribed by a podiatrist.

A third frequently encountered cause of peripheral neuropathy is also due to underlying metabolic causes. The most frequent cause of metabolic neuropathy is related to uncontrolled long-standing diabetic neuropathy. In this case, glucose within the bloodstream is not metabolized appropriately, and it ends up going into the peripheral nerves causing edema and dysfunction of the nerve conduction mechanism. Consistent blood sugar control with appropriate oral and if necessary insulin and low glycemic foods can help to manage this.

Another aspect of metabolic and dietary neuropathy is that of deficiency of several key vitamins and nutrients in the body that are essential for proper nerve health function and metabolism. Which for example is vitamin B1, B6, and B 12 along with folic acid.

Furthermore, any chronic long-standing inflammatory state due to long-term stress, poor diet, chronic alcoholism, uncontrolled systemic disease, can cause the body to be in a pro-inflammatory and depleted state, several little chemicals known as free radicals have a damaging effect on the myelin sheath, which is a fatty tissue that encases the nerves and similar to insulation and covering for a wire, this Myelin sheath helps both to insulate and protect the nerve and also to propagate nerve conduction and impulses.

Certain key antioxidants, for example, benfotiamine, glutathione, alpha-lipoic acid, the B vitamin complex have all demonstrated to be free radical scavengers, thereby decreasing the deleterious effects that these inflammatory chemicals are known to cause in the body and specifically the peripheral nerves. This is why a thorough history and physical is necessary often clarifying underlying medical issues and ordering a blood panel to assess for metabolic and electrolyte deficiencies can help to assess if nutritional supplementation is needed in order to treat an underlying dietary deficiency leading to peripheral neuropathy. See your Certified Foot and Ankle Specialist today to help determine the cause and treatment for your peripheral neuropathy.

Felipe Peterson, DPM