Peripheral neuropathy occurs when nerves outside the brain and spinal cord become damaged or do not work properly. These nerves form the peripheral nervous system, which carries messages between the brain and spinal cord and the rest of the body.
For many people, the first signs are unusual sensations in the feet or hands. These may include numbness, tingling, pins and needles, burning pain or sharp, shooting sensations. Other people develop muscle weakness, balance problems or difficulty detecting heat, cold and injuries.
Peripheral neuropathy is not one single disease. It is a broad term covering many disorders affecting peripheral nerves. Diabetes is one of the most important causes, but nerve injuries, vitamin deficiencies, infections, autoimmune diseases, certain medicines, excessive alcohol use, toxins and inherited conditions can also cause neuropathy.
Finding the underlying cause matters because some forms of peripheral neuropathy can improve when the cause is identified and treated early.
What Is the Peripheral Nervous System?
The nervous system can broadly be divided into two major parts.
The central nervous system consists of the brain and spinal cord.
The peripheral nervous system consists of nerves outside the brain and spinal cord. These nerves create a communication network connecting the central nervous system with the skin, muscles, internal organs and other parts of the body.
Peripheral nerves can be grouped according to their functions.
Sensory nerves
Sensory nerves carry information about touch, pain, temperature, vibration and body position.
Damage to sensory nerves can cause:
Numbness
Tingling or pins and needles
Burning sensations
Sharp or shooting pain
Increased sensitivity to touch
Reduced ability to feel pain or temperature
Motor nerves
Motor nerves carry signals that control voluntary muscle movement.
Damage to motor nerves may cause:
Muscle weakness
Muscle cramps
Muscle twitching
Difficulty walking
Problems using the hands
Muscle wasting in more severe cases
Autonomic nerves
Autonomic nerves help regulate body functions that occur largely without conscious control.
These include:
Blood pressure
Heart rate
Digestion
Sweating
Bladder function
Sexual function
Damage to autonomic nerves can therefore produce symptoms involving several different body systems.
What Are the Symptoms of Peripheral Neuropathy?
Symptoms depend on which nerves are damaged and the underlying cause.
Many forms of polyneuropathy affect the longest nerves first. Because the nerves extending to the feet are particularly long, symptoms commonly begin in the toes and feet before gradually progressing upward. The hands may become affected later.
Common symptoms include:
Tingling in the feet or hands
Numbness
Burning pain
Sharp, stabbing or shooting pain
Increased sensitivity to touch
Reduced ability to detect temperature
Muscle weakness
Muscle cramps
Poor coordination
Loss of balance
Difficulty walking
Some people experience allodynia, where normally painless contact, such as clothing or bedsheets touching the skin, becomes painful.
Loss of sensation can sometimes be more dangerous than pain. Someone who cannot properly feel the bottom of the foot may not notice a cut, blister, burn or other injury.
Symptoms of Autonomic Neuropathy
When autonomic nerves are affected, symptoms may include:
Dizziness or light-headedness when standing
Abnormal sweating
Heat intolerance
Constipation or diarrhoea
Digestive problems
Bladder problems
Sexual dysfunction
Problems regulating blood pressure
These symptoms can occur with many other medical conditions, so experiencing them does not automatically mean someone has peripheral neuropathy.
What Causes Peripheral Neuropathy?
Peripheral neuropathy has many possible causes.
Sometimes a specific cause can be identified and treated. In other cases, extensive investigation may not reveal a clear cause.
1. Diabetes
Diabetes is one of the most important causes of peripheral neuropathy.
Persistently high blood glucose can damage nerves and the small blood vessels supplying them.
Diabetic peripheral neuropathy commonly affects the feet and legs and may cause numbness, tingling, burning or pain.
Loss of sensation in the feet is particularly important because someone may develop a cut, blister or wound without noticing it.
People living with diabetes should therefore pay close attention to foot care and attend recommended diabetes reviews.
2. Nerve Injury or Compression
Peripheral nerves can be damaged by injury or prolonged compression.
Possible causes include:
Road traffic injuries
Falls
Sports injuries
Fractures
Dislocations
Repetitive movements
Prolonged pressure on a nerve
Carpal tunnel syndrome is a familiar example. It occurs when the median nerve becomes compressed at the wrist.
Damage to the common peroneal nerve around the knee can sometimes cause foot drop, making it difficult to lift the front of the foot properly.
3. Vitamin Deficiencies and Excesses
Certain nutritional deficiencies can damage peripheral nerves.
Vitamin B12 deficiency is an important example.
However, taking excessive amounts of vitamins is not necessarily safe. High intake of vitamin B6 over time can itself cause peripheral neuropathy.
This is why unexplained tingling or numbness should not automatically be treated with high-dose vitamin supplements without appropriate medical assessment.
4. Excessive Alcohol Use
Long-term heavy alcohol consumption can contribute to peripheral nerve damage.
Alcohol may damage nerves directly and can also contribute to nutritional deficiencies.
Reducing or stopping harmful alcohol consumption may therefore form part of treatment when alcohol is contributing to neuropathy.
5. Autoimmune and Inflammatory Conditions
Some diseases cause the immune system to attack peripheral nerves.
Examples include:
Guillain-Barré syndrome
Chronic inflammatory demyelinating polyneuropathy (CIDP)
Sjögren syndrome
Rheumatoid arthritis-associated neuropathy
Some forms of vasculitis
These conditions require medical evaluation because some may need specialised treatment.
6. Infections
Certain infections can directly damage peripheral nerves or trigger immune responses that affect them.
Examples include:
HIV
Shingles
Leprosy
Lyme disease in regions where it occurs
Certain other viral and bacterial infections
Some infections can also trigger Guillain-Barré syndrome.
7. Kidney and Other Metabolic Conditions
Advanced kidney disease can contribute to peripheral neuropathy because substances normally removed from the blood may accumulate in the body.
Certain liver, thyroid and other metabolic disorders may also be associated with neuropathy.
8. Medicines
Some medicines can cause peripheral neuropathy as an adverse effect.
One important example is chemotherapy-induced peripheral neuropathy.
Not every chemotherapy medicine causes neuropathy, and not everyone receiving chemotherapy develops it.
If numbness, tingling or nerve pain begins while taking prescribed medication, do not stop the medicine yourself. Discuss the symptoms with the healthcare professional managing your treatment.
9. Toxins
Exposure to certain heavy metals, industrial chemicals and other toxic substances can damage peripheral nerves.
A person's occupational and environmental exposure history can therefore be important when investigating unexplained neuropathy.
10. Inherited Conditions
Some peripheral neuropathies are inherited.
Charcot-Marie-Tooth disease is one of the better-known inherited peripheral nerve disorders.
A family history of unexplained neuropathy, muscle weakness or walking difficulties can therefore provide an important diagnostic clue.
11. Unknown Causes
Sometimes doctors cannot identify the underlying cause despite appropriate investigation.
This may be described as idiopathic peripheral neuropathy.
Types of Peripheral Neuropathy
Peripheral neuropathy can also be classified according to the number and pattern of nerves affected.
Mononeuropathy
Mononeuropathy involves damage to a single peripheral nerve.
It can result from trauma, compression or another local problem.
Examples include:
Carpal tunnel syndrome
Ulnar neuropathy
Radial nerve injury
Peroneal nerve injury
Symptoms depend on the particular nerve affected.
Polyneuropathy
Polyneuropathy affects multiple peripheral nerves.
Symptoms frequently occur on both sides of the body and often begin in the feet.
Diabetic peripheral neuropathy is a common example.
Mononeuritis Multiplex
Mononeuritis multiplex involves damage to separate individual nerves in different parts of the body.
It may occur with inflammatory conditions, including some forms of vasculitis.
Peripheral Neuropathy and Diabetes
Diabetic neuropathy deserves particular attention because reduced sensation in the feet can lead to serious complications.
Someone with decreased sensation may not immediately notice:
Cuts
Blisters
Burns
Pressure injuries
Foot ulcers
Infections
A wound can therefore become considerably worse before it causes noticeable pain.
People living with diabetes should regularly inspect their feet, wear appropriate footwear and seek medical attention for wounds that are not healing normally.
Good blood-glucose management is also an important part of reducing the risk and progression of diabetes-related complications.
How Is Peripheral Neuropathy Diagnosed?
There is no single test that diagnoses every type of peripheral neuropathy.
Diagnosis usually begins with a detailed medical history and neurological examination.
A healthcare professional may ask about:
When symptoms started
Where symptoms occur
Whether symptoms are progressing
Diabetes
Alcohol consumption
Current medicines
Previous infections
Diet and nutritional problems
Occupational exposures
Family history
Other medical conditions
The neurological examination may assess muscle strength, reflexes, balance, coordination and different types of sensation.
Blood Tests
Blood tests can help identify possible underlying causes.
Depending on the person's symptoms and medical history, testing may investigate conditions such as diabetes, vitamin B12 deficiency, kidney disease, liver disease, thyroid disorders, infections or other metabolic problems.
Not everyone requires every test.
Nerve Conduction Studies
Nerve conduction studies measure how quickly and effectively electrical signals travel through particular nerves.
They can help determine whether nerves are damaged and provide information about the pattern of neuropathy.
Electromyography
Electromyography, commonly called EMG, measures electrical activity within muscles.
It is often performed alongside nerve conduction studies and can help distinguish certain nerve disorders from muscle disorders.
Imaging
MRI or CT scans may sometimes be required when doctors suspect a structural problem such as nerve compression, spinal disease or a tumour.
Imaging is not required for every person with peripheral neuropathy.
Skin Biopsy
A small skin biopsy can sometimes help evaluate small nerve fibres, particularly when small-fibre neuropathy is suspected.
Nerve Biopsy
Nerve biopsy is much less commonly required.
It is generally reserved for selected circumstances where examining nerve tissue could provide important diagnostic information that cannot be obtained through less invasive methods.
How Is Peripheral Neuropathy Treated?
There is no single treatment for every case of peripheral neuropathy.
Treatment depends on:
The underlying cause
The nerves affected
The severity of nerve damage
The symptoms experienced
Whenever possible, treatment begins by addressing the underlying cause.
Examples include:
Improving diabetes management
Correcting vitamin B12 deficiency
Reducing harmful alcohol consumption
Treating an underlying infection when appropriate
Managing autoimmune disease
Relieving nerve compression
Reviewing medicines that may be contributing to neuropathy
Some nerve problems can improve significantly once the underlying cause is corrected.
Other nerve damage may be permanent.
Earlier identification of a treatable cause may help prevent additional nerve damage.
Medicines for Neuropathic Pain
Neuropathic pain behaves differently from many ordinary types of pain.
Medicines that may be prescribed for nerve pain in appropriately selected patients include:
Amitriptyline
Duloxetine
Gabapentin
Pregabalin
Although some of these medicines were originally developed for conditions such as depression or epilepsy, they can also alter nerve signalling and reduce neuropathic pain.
Topical treatments such as lidocaine or capsaicin may be considered for certain people with pain affecting a limited area.
The appropriate treatment depends on the individual, other medical conditions, medicines being taken and potential side effects.
Opioids are generally not preferred for long-term management of neuropathic pain because their risks can outweigh their benefits.
Treatment should therefore be individualised by an appropriate healthcare professional.
Physiotherapy and Rehabilitation
Peripheral neuropathy can affect strength, balance and mobility.
Some people may benefit from:
Physiotherapy
Strength exercises
Balance training
Walking aids
Splints or braces
Appropriate footwear
These approaches can help preserve mobility and reduce the risk of falls.
Immune Treatments
Certain inflammatory or autoimmune neuropathies require specialised treatment.
Depending on the specific diagnosis, specialists may use treatments such as intravenous immunoglobulin, corticosteroids, plasma exchange or medicines that modify immune activity.
These treatments are not routine treatments for every person with peripheral neuropathy.
Can Surgery Treat Peripheral Neuropathy?
Sometimes.
Surgery may help when symptoms result from compression of a particular nerve and appropriate conservative treatments have not been successful.
Carpal tunnel syndrome is one example.
Widespread polyneuropathy, however, is generally not treated surgically.
Foot Care When You Have Peripheral Neuropathy
Reduced sensation in the feet can make injuries difficult to detect.
This is particularly important for people living with diabetes.
Helpful precautions include:
Inspecting the feet regularly for cuts, blisters, redness or wounds
Wearing properly fitting footwear
Avoiding walking barefoot where injuries could occur
Seeking medical attention for wounds that do not heal
Attending recommended diabetes and foot-care appointments
Do not assume that a wound is harmless simply because it does not hurt.
Loss of sensation can mean that a significant injury produces little or no pain.
Can Peripheral Neuropathy Be Prevented?
Not every type of peripheral neuropathy can be prevented.
However, some causes and complications can be reduced.
Helpful measures include:
Managing diabetes appropriately
Eating a balanced diet
Avoiding harmful alcohol consumption
Exercising regularly where medically appropriate
Avoiding tobacco
Reducing unnecessary exposure to toxic chemicals
Using appropriate protective equipment where occupational exposure is possible
Avoiding excessive vitamin supplementation without medical advice
Reviewing medicines with a healthcare professional when neuropathy develops
Maintaining good foot care when sensation is reduced
When Should You See a Doctor?
Seek medical assessment if you develop persistent or unexplained:
Numbness
Tingling
Burning pain
Shooting nerve pain
Muscle weakness
Loss of balance
Reduced sensation in your hands or feet
Early assessment is particularly important if symptoms are progressing or if you are living with diabetes.
When Is Peripheral Neuropathy an Emergency?
Some neurological symptoms require urgent medical attention.
Seek urgent medical care if you develop:
Rapidly worsening muscle weakness
Difficulty breathing
Difficulty swallowing
Sudden inability to walk
Weakness that is rapidly spreading
New loss of bladder or bowel control together with weakness or numbness
Rapidly progressive weakness can occur with serious neurological disorders such as Guillain-Barré syndrome and requires urgent assessment.
Frequently Asked Questions
Can peripheral neuropathy be cured?
It depends on the cause.
Some neuropathies can improve substantially when an underlying problem such as vitamin deficiency, nerve compression or another treatable condition is corrected.
Other forms may result in permanent nerve damage.
Even when complete recovery is not possible, treatment may reduce symptoms and help prevent further deterioration.
What does peripheral neuropathy feel like?
People describe neuropathy in different ways.
Common descriptions include pins and needles, burning, electric-shock sensations, shooting pain and numbness.
Some people experience weakness or loss of balance without significant pain.
Why does neuropathy often start in the feet?
Many polyneuropathies are length-dependent.
The nerves extending from the spinal cord to the feet are among the longest peripheral nerves in the body. Their distant nerve endings can therefore be particularly vulnerable to certain types of damage.
Symptoms may consequently begin in the toes and feet before gradually progressing upward.
Can diabetes cause numb feet?
Yes.
Diabetes can damage peripheral nerves and cause reduced sensation, tingling, burning or pain in the feet.
Persistent numbness should be assessed because loss of sensation increases the risk that foot injuries will go unnoticed.
Can vitamin deficiency cause neuropathy?
Yes.
Vitamin B12 deficiency is one recognised cause of peripheral neuropathy.
However, excessive vitamin B6 intake can also damage nerves.
Do not assume that taking large doses of vitamin supplements will treat unexplained neuropathy.
Can alcohol cause peripheral neuropathy?
Yes.
Long-term excessive alcohol consumption can contribute to nerve damage directly and through associated nutritional deficiencies.
Is peripheral neuropathy always caused by diabetes?
No.
Diabetes is an important cause, but peripheral neuropathy can also result from injuries, nerve compression, vitamin deficiencies, infections, autoimmune diseases, medicines, toxins, kidney disease, inherited conditions and other causes.
Sometimes no cause is identified.
Can damaged peripheral nerves heal?
Peripheral nerves have some capacity for recovery, particularly when the underlying cause is identified and corrected.
However, recovery can be slow and some nerve damage may be permanent.
The outlook depends on the cause, severity and duration of the neuropathy.
Key Takeaways
Peripheral neuropathy occurs when nerves outside the brain and spinal cord become damaged.
Symptoms depend on the nerves affected but commonly include numbness, tingling, burning or shooting pain, muscle weakness and balance problems.
Diabetes is an important cause, but neuropathy can also result from nerve compression, injuries, vitamin deficiencies, excessive alcohol use, autoimmune diseases, infections, medicines, toxins, kidney disease and inherited conditions.
Diagnosis should focus not only on confirming nerve damage but also on determining why the nerve damage occurred.
Treatment therefore differs from one person to another.
Persistent numbness, tingling, unexplained nerve pain or weakness should not simply be ignored. Identifying a treatable cause early may help prevent additional nerve damage.
References and Further Reading
National Institute of Neurological Disorders and Stroke (NINDS): Peripheral Neuropathy
https://www.ninds.nih.gov/health-information/disorders/peripheral-neuropathy
NHS: Peripheral Neuropathy
https://www.nhs.uk/conditions/peripheral-neuropathy/
NHS: Peripheral Neuropathy Diagnosis
https://www.nhs.uk/conditions/peripheral-neuropathy/diagnosis/
NHS: Peripheral Neuropathy Treatment
https://www.nhs.uk/conditions/peripheral-neuropathy/treatment/
Updated: August 2026
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