“My feet feel like they’re on fire sometimes. Then sometimes they seem like they’re asleep or kind of numb — makes it hard to get to sleep some nights. I’m wondering if I’ve just got bad circulation.”

Mr. Thomas was describing a common set of symptoms, one that hits more than 10% of folks at one time or another.

His symptoms were not from poor circulation. As it turned out, he had a condition known as peripheral neuropathy. PN results when nerves that carry messages to and from the brain and spinal cord to the feet and hands and rest of the body are damaged or diseased.

The symptoms of PN can be described as numbness, burning, tingling, feelings like the area is asleep, a pins and needles sensation, weakness or just a doughy feeling of altered sensation. Most commonly it affects the feet, but can also involve the hands and sometimes will gradually move upward to the legs or arms.

PN has a range of causes. The most common cause is diabetes, especially if the diabetes has been present for a number of years or has not been well controlled. Other causes include vitamin B12 or folic acid deficiencies, exposure to certain toxins (such as arsenic or certain chemotherapies), trauma, infection and autoimmune problems. In roughly 25% there is no identifiable cause.

Unfortunately, only a minority of PN is reversible, but the earlier it is caught the better the chance for this. In the case of diabetes, the best approach is excellent control of the diabetes to minimize the chance of PN ever setting in.

If persistent PN occurs, the pain and burning can usually be greatly reduced with medications such as gabapentin, Lyrica and others. This can give a substantial amount of relief and allow for a good night’s sleep. However, there are no meds that reliably take away the numbness and restore normal feeling.

One important precaution if you have PN is to regularly check the bottoms of your feet and any other areas that are numb. A good routine is to do this as you go to bed. That way you can notice if there are any cuts or sores that you didn’t feel due to the numbness. This allows you to prevent unrecognized infections that can become a big enough problem to create long-term skin ulcers or even lead to amputations.

PN certainly needs attention even if a specific cause can’t always be determined. Sophisticated testing such as nerve conduction studies and MRIs are sometimes needed as well. Likewise, a referral to a neurologist will sometimes be undertaken if your primary care doctor believes it might be helpful. So, if your feet or hands keep falling asleep, don’t ignore it; get it checked out.

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