The Foot Book by Jonathan D. Rose & Vincent J. Martorana

Author:Jonathan D. Rose & Vincent J. Martorana
Language: eng
Format: epub
Publisher: Johns Hopkins University Press
Published: 2011-10-15T00:00:00+00:00

Injury to the Outer Layer of a Nerve: Peripheral Neuropathy

When the outer insulating layer of a nerve becomes damaged, the condition is called a peripheral neuropathy. This condition can involve a single nerve or many nerves at once. Damage to a single nerve (mononeuropathy) can be the result of an injury or compression to the nerve, and the effects are localized to the specific part of the body where the nerve goes. Damage to more than one nerve (polyneuropathy) can be caused by an extremely wide range of disorders and conditions, including diabetes, anemia, inflammatory arthritis, poor circulation, kidney failure, infection (such as Lyme disease), HIV, lupus, and scleroderma. Other causes of polyneuropathy are cancer, chemotherapy, trauma to nerves, hereditary neurological conditions (for example, Friedreich ataxia, Charcot-Marie-Tooth disease), alcoholism, vitamin deficiency, and exposure to heavy metals (like lead, arsenic, mercury, gold, or silver). Last, polyneuropathy can occur when nerves are compressed by a tight cast or brace, by sitting with the legs crossed, or by lying in one position for a prolonged period, such as during a long surgical operation. The effects of a polyneuropathy tend to be more general, affecting many areas of the body.

Peripheral neuropathy can cause sensory or motor symptoms, although sensory symptoms are more common. They begin gradually with numbness, tingling, burning, and pain that can be sharp, jabbing, and electric. The pain is often worse at night, when the brain is not being simultaneously bombarded with input from the other senses—sight, sound, vision, taste, and smell. Symptoms usually begin in the toe and extend up the leg. Patients often report the sensation of wearing a sock or walking on a bunched-up sock. Other symptoms include uncoordination, loss of balance, and hypersensitivity to touch. When motor dysfunction occurs, the muscles become wasted, or atrophied. The muscles controlled by the affected nerve become weak or paralyzed, and they may cramp or twitch. The foot and ankle can change structurally as the unaffected muscles overpower the weaker muscles, causing the foot to point inward or outward, and possibly up or down.

A physician diagnoses peripheral neuropathy by taking a complete medical history and conducting a physical examination to assess sensation, reflexes, and muscle strength in the lower leg and foot. You may also undergo noninvasive electrodiagnostic testing, as described for lower back nerve entrapment. If you have a known condition or situation that could be contributing to the neuropathy, the physician will determine if it’s under adequate control. For example, it is essential to control blood sugar in a person with diabetes, provide vitamin B12 to a person with pernicious anemia, and stop alcohol consumption by a person with alcoholism.

The damage to nerves is often progressive and permanent, so treatment of peripheral neuropathy aims to control the symptoms, increase your ability to function independently, and prevent injury or further injury to the lower limb. The treatment differs depending on the cause of the neuropathy. Pharmacological treatment assists in pain relief and diminishes uncomfortable sensations such as numbness and tingling.

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