Peripheral neuropathy is becoming more common than in previous decades. The number of people diagnosed with peripheral neuropathy is increasing each year. However, many people may have the condition and be unaware of it.

For many patients, the earliest symptoms begin with an aggravating burning type of pain, often starting in the feet. The explanation for this is that the nerves to the feet are the longest nerves in the body, making them more vulnerable to damage.

As the condition progresses, the patient may realize the burning pain is accompanied by tingling. The pain usually becomes more frequent and intense over time. The symptoms often occur only at nighttime at first. As the condition progresses the burning, tingling and pain soon can be felt all day long.

The area affected also expands. From the toes to the whole foot, then ankle and lower legs. It may begin to affect the hands and arms.

After a period of time, the intensity of the burning pain and tingling seems to subside and is replaced by numbness. Instead of feeling noxious sensations in the feet and lower legs, the patient realizes they don’t feel anything at all in the affected areas.

This numbness means that the condition has taken a dangerous turn for the worse. It also means the patient is now vulnerable to more problematic complications. When the condition has progressed to numbness, this means more of the nerves have been severely damaged, the patient now is at risk of serious damage to the feet from wounds, blisters, eventually non-healing ulcers and possibly leading to amputation.

Once numbness has begun, the patient will notice problems with balance. Subtle at first, having a hard time getting dressed or maybe stumbling occasionally. Then as the numbness gets worse, the risk of falling and becoming injured becomes serious.

The leading cause of accidental death for seniors is falling.

As peripheral neuropathy progresses, patients may begin to report their feet feel cold. This means the blood flow to the feet is diminishing. This leads to more nerve damage. Later in the progression, patients may feel that their feet are warm, perhaps even feeling like their feet are on fire. Yet, when they touch their feet, the skin feels cool. This is due to the blood flow being reduced, leaving the feet cooler, and more nerve damage, creating the sensation of burning.

“My feet felt like they were on fire, but when I touched the skin, it felt cool.”

Patients often notice dry skin, loss of body hair on the lower legs and discoloration such as the skin looking more bluish. All these changes are the result of blood flow changes, decreased oxygen delivery and progressive nerve damage.

With peripheral neuropathy affecting the feet, the toenails are more likely to become thicker, turning yellowish. Fungal infection is common and proper foot care is essential. Again, this is due to gradually losing normal blood flow, lack of oxygenation and nerve damage.

Some patients will develop extreme sensitivity to touch. Patients may say their clothes hurt. Just the touch of clothing can be difficult to bear.

Peripheral neuropathy can affect sensory and motor nerves. The sensory nerves are the smaller nerves that transmit sensations. Motor nerves are nerves that control muscles, thereby affecting motion.

Often overlooked in the management of peripheral neuropathy are the effects the condition can have on the autonomic nervous system. Autonomic nerves are part of the peripheral nervous system just as the motor nerves and sensory nerves.

Autonomic nerves control the internal organs and functions of the body. That means these nerves control all of the functions of the body that are normally being handled automatically – in the background, without our direct effort.

Patients with peripheral neuropathy often report heat intolerance, excessive sweating or possibly not being able to sweat. The sweat glands are controlled by autonomic nerves.

More concerning for some patients is the impact of bowel and bladder dysfunction. Realize that the bowel, bladder and all other organs are managed by the autonomic nervous system.

Patients may experience increasing difficulty with bowel movements. Or they may have a problem controlling their bowels. Just as the bowels are controlled by peripheral autonomic nerves, so is the bladder. Therefore, problems with bladder control may begin to appear. These types of problems become worse as the condition progresses.

Blood pressure and even heart rate are controlled by peripheral autonomic nerves. This means the patient may experience drops in blood pressure, leading to dizziness or lightheadedness.

Dr. Mark Kestner is a licensed chiropractic physician and acupuncturist with 30-plus years of experience focused primarily on treating complex and chronic spine, joint and neurological conditions in Murfreesboro. His office is at 1435 NW Broad St. Contact him at

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