Leg Neuropathy: Symptoms, Causes, and How It Is Diagnosed

At first you notice it not with your eyes: the foot feels as if it is in a thick sock, and the floor beneath it is softer and farther away than before. Then burning or a shooting pain appears — and you begin to listen to your own legs. Neuropathy is not a separate symptom but a condition of the peripheral nerves, and it is easier to understand if you know exactly what is damaged.

What is leg neuropathy

The peripheral nervous system is a network of nerves outside the brain and spinal cord: sensory nerves transmit pain and touch, motor nerves control muscles, and autonomic nerves regulate blood pressure and bladder function. Neuropathy means that one or more of these nerves are not working properly — a single nerve, a group of nerves, or all the nerves in the body may be affected.

Polyneuropathy is the most common form. It starts with the longest nerves, so the first symptoms appear in the feet, then the process seems to rise higher and later reaches the hands. By course, acute forms (up to 4 weeks), subacute forms (4–8 weeks), and chronic forms (longer than 8 weeks) are distinguished. In the UK, peripheral neuropathy affects nearly 1 in 10 people over the age of 55.

Symptoms of neuropathy of the lower limbs and feet

Symptoms depend on which nerves are damaged. Most often the picture is as follows:

• numbness and tingling in the feet or hands;
• burning, stabbing, or shooting pain;
• loss of balance and coordination;
• muscle weakness, especially in the feet;
• the person does not notice a cut, a callus, or water that is too hot.

The sensations are usually constant, although they may come and go. Because of the numbness, it is harder to tell where the foot is, and unsteadiness appears when walking. The legs give way, the person stumbles over their own toes, muscles twitch or cramp, and over time they become smaller.

Causes of peripheral neuropathy of the legs

The most common causative factor is diabetes mellitus: elevated blood glucose levels over years damage the nerves, and this condition is called diabetic polyneuropathy. Less often, nerves are affected by trauma, a viral infection such as shingles, the side effects of certain medications, or excessive alcohol consumption.

The list is broader: autoimmune diseases (rheumatoid arthritis, lupus), chronic kidney disease, HIV and hepatitis C, deficiency of vitamins B1, B6, or B12, hypothyroidism, impaired blood flow in the legs, tumors, hereditary forms, prolonged pressure on a nerve — for example, from an improperly fitted cast, splint, or crutches. Quite often the cause cannot be found.

How neuropathy is diagnosed

The doctor examines the patient and asks about symptoms and health history. Blood and urine tests help look for the cause of nerve damage. Electromyography (testing the electrical activity of muscles) and nerve conduction velocity studies are possible. Less often, nerve or skin biopsy, genetic testing, and cerebrospinal fluid analysis are used when inflammation or infection is suspected. If necessary, the patient is referred to a neurologist: the earlier the diagnosis is made, the greater the chance of limiting the damage.

Possible complications

The prognosis depends on the cause and on which nerves are affected: some cases improve with treatment of the underlying disease, while some remain persistent or worsen. The main danger is a foot with poor sensation. An unnoticed callus or cut turns into an ulcer, the ulcer becomes infected, and without treatment gangrene develops; in severe cases the leg has to be amputated. A separate scenario is damage to the autonomic nerves that regulate the heart and blood vessels; such conditions require medical monitoring.

When leg symptoms require a visit to a neurologist

Reasons to see a doctor include pain, tingling, or loss of sensation in the feet, impaired balance, weakness, and a cut or ulcer on the leg that does not heal. With diabetes and other high-risk conditions, regular examinations with testing of nerve function are needed. If numbness and burning in the feet have appeared or are spreading higher, this is a reason not to postpone the visit.

Leg neuropathy by itself is not a reason to call an ambulance. 103 or 112 — if a stroke or heart attack is suspected, in particular if sudden weakness, sweating, shortness of breath, nausea, or vomiting have appeared.

This material is for reference: it explains how neuropathy is diagnosed but does not replace a doctor's consultation — an examination and tests show what is happening specifically with your nerves.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer