Millions live with burning feet, numb toes, or sharp electric shocks in the hands. These signs point to damage in the nerves that carry signals to and from the limbs. The causes range from diabetes to chemotherapy, vitamin gaps, infections, and more.
This guide explains causes, tests, treatments, and daily care. It uses clear language and the best current evidence. You will see 2025 trends, new therapies, and links to trusted sources. Use it to prepare for your next clinic visit and to ask smart questions.
Peripheral neuropathy means damage to nerves outside the brain and spinal cord. These nerves control feeling, movement, and automatic body functions like sweat and blood pressure. When they are injured, signals get weak, mixed, or overactive.
The problem can affect one nerve, several nerves, or many nerves at once. It can come on slowly or fast. Some cases improve when the cause is fixed. Others need long-term care to control pain and protect function.
“Peripheral neuropathy symptoms” vary by nerve type. Sensory nerves cause numbness, tingling, burning, or sharp “electric” pain. Many people notice worse pain at night. Balance can suffer because the feet cannot “feel” the ground.
Motor nerve damage causes weakness, cramps, or hand and foot muscle loss. Autonomic nerve damage can cause dizziness on standing, sweat changes, constipation, diarrhea, or sexual problems. New foot sores, frequent tripping, or dropping objects are also red flags.
Sensory neuropathy is the most common. It often starts in the toes and fingers and moves upward in a “stocking-glove” pattern. Pain can be mild or severe. Light touch may feel painful, a sign called allodynia.
Motor neuropathy targets muscles. People struggle to climb stairs, open jars, or lift the ankle (foot drop). Autonomic neuropathy affects automatic functions. It can cause dry eyes or mouth, slow stomach emptying, and abnormal sweating. Many people have mixed types.
Diabetes is the leading cause worldwide. High blood sugar damages tiny blood vessels and nerve cells over time. Poorly controlled diabetes raises risk and severity. Drinking alcohol heavily and being low in vitamin B12 also harm nerves.
Other causes include chemotherapy, kidney disease, infections like shingles or HIV, autoimmune conditions, thyroid disease, and some genetic disorders. Medications, such as certain antibiotics or cancer drugs, can trigger nerve injury. Sometimes no clear cause is found; doctors call this idiopathic.
Long-term high blood sugar is a major driver. Better glucose control lowers risk and slows progression. The American Diabetes Association’s 2024 standards stress A1C goals tailored to the person and tight blood pressure and lipid control to protect nerves and vessels. Metformin can lower vitamin B12 over time, so periodic B12 checks are advised.
Pain control and foot protection are core goals. Duloxetine, pregabalin, and gabapentin have the strongest evidence for painful diabetic neuropathy. For some adults with severe, refractory pain, spinal cord stimulation has shown sustained benefit up to 24 months in randomized trials. Daily foot checks and well-fit shoes prevent ulcers and amputations.
CIPN is common with drugs like taxanes, platinum agents, and bortezomib. It often starts during treatment and can last. Numbness and pain in the hands and feet are typical. Dose changes sometimes help; always discuss risks and benefits with your oncology team.
Prevention is hard. Large studies do not support routine supplements for prevention. Exercise training shows promise for reducing symptom severity. For established painful CIPN, guidelines support duloxetine as first-line. Non-drug aids like balance training and safe-home changes reduce falls and injuries.
Diagnosis starts with history and exam. Your clinician asks about symptoms, timing, and exposures. They check strength, reflexes, and feeling with light touch, pinprick, and vibration. A simple tuning fork test can reveal loss of vibration sense.
Basic blood tests look for common, treatable causes. These include glucose or A1C, B12 with methylmalonic acid, thyroid tests, kidney function, and sometimes tests for infection or autoimmunity. Finding and fixing a cause early improves outcomes.
Electrodiagnostic tests help map nerve damage. Nerve conduction studies measure how fast and strong signals travel. Electromyography (EMG) checks the muscle response. Together they show whether the problem is in the myelin (the insulation) or the axon (the wire).
Some people have small fiber neuropathy. These tiny pain and temperature fibers do not show on standard nerve studies. A skin biopsy can count nerve endings in the skin and confirm the diagnosis. Sweat tests and quantitative sensory testing may add detail in unclear cases.
See a neurologist or a specialist clinic if symptoms progress fast, are very asymmetric, or include severe weakness, bowel or bladder issues, or significant weight loss. These can signal treatable inflammatory causes like CIDP, vasculitis, or other urgent problems.
Referral also helps if pain does not respond to first-line treatments, if diagnosis is unclear, or if you have complex medical needs. Specialists can arrange immunotherapy for immune-mediated neuropathies and advanced pain options for refractory cases.
Treatment has two tracks. First, address the cause when possible. Control diabetes, correct vitamin deficiencies, stop harmful drugs, or treat infection or autoimmunity. Second, reduce pain and protect function with targeted therapies.
Care plans mix medicines, physical therapy, foot protection, and self-care. Goals include better sleep, safe walking, and less pain. Plans are tailored and should be reviewed often. Expect adjustments as symptoms change.
First-line drugs are duloxetine (an SNRI), pregabalin, and gabapentin (gabapentinoids), and in some cases tricyclic antidepressants like amitriptyline or nortriptyline. These reduce pain by calming overactive nerve signals. Start low and go slow to limit side effects like sleepiness or dizziness.
Topical options help localized foot pain. Lidocaine 5% patches can ease burning areas. Capsaicin 8% patches, applied in the clinic, can reduce pain for weeks by desensitizing nerve endings. Opioids are not first-line. If used at all, they should be short-term and carefully monitored due to risks.
Exercise improves balance, mood, and glucose control. Start with low-impact activities like walking, cycling, or water exercise. Add strength and balance training to reduce fall risk. A physical therapist can tailor a safe plan.
Other tools include cognitive behavioral therapy for pain coping, TENS for some cases, and properly cushioned footwear. Daily foot checks catch blisters and cuts early. Keep floors clear, add night lights, and use handrails to prevent falls. Small changes protect independence.
Pain and numbness affect daily life. Simple routines help. Set a fixed sleep schedule. Limit caffeine late in the day. Try relaxation or paced breathing. Use pillows to reduce contact pain in bed. Warm—not hot—foot baths can soothe, but test water with your hand first to avoid burns.
Protect your feet. Wear socks and shoes at home. Choose wide, cushioned footwear that does not rub. Trim nails straight across. See a foot care specialist for thick nails or calluses. Report any open sore at once. Fast care prevents infection and bone damage.
Peripheral neuropathy symptoms can flare with stress, poor sleep, or high blood sugar. Track triggers in a simple diary. Share it with your clinician. Small changes, like shorter activity blocks or rest breaks, can reduce flares.
Use aids if needed. A cane or walker can steady your step. Shoe inserts improve pressure distribution. Voice-to-text and jar openers protect sore hands. Ask for a home safety review if you have frequent stumbles. Prevention is stronger than any brace.
Food is part of care. Aim for a plate rich in fiber, lean protein, and healthy fats. If you take metformin, ask about periodic B12 testing. Treating B12 deficiency can reverse symptoms when caught early. Avoid heavy alcohol; it harms nerves and worsens balance.
Supplements have mixed evidence. Alpha-lipoic acid may help some with diabetic nerve pain, but study quality varies, and long-term safety is unclear. Always discuss supplements with your clinician. They can interact with medicines and may not be safe for everyone.
Technology is adding options. Devices that stimulate the spinal cord or dorsal root ganglion can help severe, resistant diabetic nerve pain. Randomized trials show sustained relief and improved function for many patients who failed drugs. Careful selection and follow-up are essential.
Digital tools also support care. Wearables track steps, gait, and sleep. Apps guide home exercises and pacing. Telehealth keeps follow-ups regular. These tools do not replace clinicians, but they help people stick to plans and catch problems sooner.
Spinal cord stimulation delivers small electrical pulses to the spinal cord. It can reduce pain signals from the feet and legs. Trials in painful diabetic neuropathy report durable pain relief and better quality of life over two years for responders. Surgical risks and costs exist, so teams screen carefully.
Other device options include TENS, scrambler therapy, and peripheral nerve stimulation. Evidence varies by device and diagnosis. For some, these reduce pain or improve function. Discuss goals, trial periods, and exit criteria before committing. Clear plans prevent frustration.
Clinics now use digital symptom trackers and electronic pain diaries. Simple weekly check-ins flag flares early. AI can help classify gait risk from wearable data and suggest balance exercises. In 2025, the focus is on privacy, usability, and real-world results, not hype.
Remote patient monitoring supports safer chemo and diabetes care. It can alert teams to rising pain scores or foot temperature changes that predict ulcers. Programs work best when data flows to a person who acts on it. Tech plus teamwork beats tech alone.
Can nerves heal? Sometimes. If the cause is fixed early, mild cases can improve over months. Severe axonal loss takes longer, and some damage is permanent. Even then, pain control, therapy, and safety steps can restore function and confidence.
Do I need imaging for peripheral neuropathy? Usually not. MRI can help if doctors suspect spine disease or nerve entrapment. Most cases are diagnosed with history, exam, blood tests, and nerve studies. Your clinician will guide the right work-up.
What about alternative therapies? Some people report relief with acupuncture or mindfulness. Evidence ranges from mixed to low-quality. These may help as add-ons if they are safe and you still use proven care. Avoid treatments that promise a cure without evidence.
Here are trusted, up-to-date resources used to build this guide. They include guidelines, meta-analyses, and large trials. Use them to verify details and to learn more about diagnosis, treatment, and safety.
When a source is older, it is because it remains the standard reference for a topic (for example, classic trials or enduring guidelines). Where possible, we cite 2023–2024 updates that shape 2025 care.
Important notes for 2025: