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A plain-language guide to understanding nerve damage in the feet and hands — from early warning signs to how doctors diagnose it.
Medically reviewed content • DD Podiatry, Bethesda, MD & McLean, VA
If you've noticed numbness, tingling, or a burning sensation in your feet, you're not alone — peripheral neuropathy affects millions of people, and it becomes more common with age. This guide walks through what's actually happening in your nerves, why it happens, how it tends to progress, and what your diagnostic and treatment options look like.
Peripheral neuropathy is damage to the peripheral nerves — the vast network of nerves outside your brain and spinal cord that carry signals to and from your muscles, skin, and internal organs. When these nerves are damaged, they can misfire, send incomplete signals, or stop transmitting altogether.
Because the nerves running to your feet are among the longest in your body, they're often among the first to show damage — which is why peripheral neuropathy so often shows up as numbness, tingling, or pain in the toes and feet before it's noticed anywhere else.
Quick fact: There are more than 100 recognized types of peripheral neuropathy, each with its own pattern, causes, and outlook. What's common to nearly all of them is that the feet are frequently affected first and worst.
Peripheral nerves carry three broad categories of signals, and neuropathy can affect one or more of them at the same time.
Affects the nerves that let you feel pain, temperature, vibration, and touch. This is the most common type felt in the feet — numbness, tingling, burning, or heightened sensitivity to touch.
Affects the nerves that control your muscles. Can lead to weakness, muscle cramping, twitching, or a loss of coordination and balance.
Affects nerves controlling involuntary functions like heart rate, digestion, blood pressure, and sweating. Often occurs alongside sensory neuropathy in conditions like diabetes.
Diabetes is the single most common identifiable cause of peripheral neuropathy in the United States, but it's far from the only one. Here are the most frequently seen causes:
Elevated blood sugar over time damages small nerve fibers, especially in the feet.
Repetitive pressure, trauma, or entrapment can damage individual nerves.
Low B12, B1, or B6 levels can impair nerve function and repair.
Chronic alcohol use is directly toxic to peripheral nerves and often depletes B vitamins.
Certain chemotherapy drugs and other medications can cause nerve damage as a side effect.
Conditions like rheumatoid arthritis or lupus can trigger the immune system to attack nerve tissue.
Certain viral and bacterial infections can damage peripheral nerves.
Inherited disorders such as Charcot-Marie-Tooth disease affect nerve structure from birth.
Idiopathic neuropathy: In roughly a quarter to nearly half of cases, no clear underlying cause is ever identified — even after thorough testing. This is called idiopathic peripheral neuropathy, and it's more common than most people realize.
Peripheral neuropathy usually doesn't appear all at once — it tends to develop gradually, often starting in the toes and slowly moving upward in what's sometimes called a "stocking and glove" pattern, since it frequently affects the feet before the hands.
Occasional tingling, "pins and needles," or numbness in the toes — often noticed at night or after long periods of standing. This is generally the best window to seek evaluation, since early intervention has the most potential impact.
Burning or sharp pain becomes more persistent, sometimes disrupting sleep. Numbness may spread further into the foot, and some patients begin noticing mild balance changes.
Muscle weakness, significant loss of protective sensation, and noticeable balance or gait changes. At this stage, the risk of falls, unnoticed injuries, and skin breakdown rises substantially.
Because neuropathy reduces your ability to feel pain, temperature, and pressure, it can mask injuries that would otherwise be obvious. This is especially serious for people with diabetes, where reduced sensation combined with impaired circulation and healing can allow small cuts, blisters, or pressure sores to go unnoticed and worsen.
Why foot checks matter: A small blister or cut that you can't feel can progress to a serious wound or infection before it's noticed. Regular foot checks — by yourself or a podiatrist — are one of the most effective ways to catch problems early.
Beyond skin and wound risk, advancing neuropathy can affect balance and increase fall risk, particularly in older adults. Addressing neuropathy early, and monitoring it consistently once diagnosed, is one of the most effective ways to reduce these downstream complications.
Diagnosing neuropathy typically starts with a conversation and a physical exam, not a single test. Your doctor will want to understand:
Depending on those findings, your doctor may order bloodwork to screen for diabetes, vitamin deficiencies, or thyroid dysfunction, and in some cases refer you for nerve conduction studies — a specialized test that measures how well electrical signals travel along your nerves and can help identify the type and severity of nerve damage.
Treatment for peripheral neuropathy generally falls into a few broad categories, often used in combination:
Where possible, this is the most effective long-term strategy — for example, improving blood sugar control in diabetes, correcting a vitamin deficiency, or stopping a medication or substance that's contributing to nerve damage.
Pain medications are commonly prescribed to help patients cope with nerve pain day to day. These can be an important part of managing quality of life, though they work by calming pain signals rather than repairing the underlying nerve damage.
Physical therapy, proper footwear, custom orthotics, and diligent foot care can all help protect the feet and maintain function as neuropathy progresses.
A newer category of treatment focuses on supporting nerve and blood vessel health directly, rather than only managing symptoms. DD Podiatry offers a systematic program built around this approach — you can read more on our peripheral neuropathy treatment page.
This guide is for general educational purposes and isn't a substitute for personalized medical advice. Every case of neuropathy is different — a consultation with your podiatrist or physician is the best way to understand your specific situation.
Peripheral neuropathy is damage to the peripheral nerves — the nerves outside the brain and spinal cord that carry signals to and from the muscles, skin, and organs. When these nerves are damaged, they can misfire or stop sending signals correctly, leading to numbness, tingling, pain, or weakness, most often in the feet and hands.
There are more than 100 recognized types. Broadly, they fall into three categories: sensory neuropathy (affecting feeling), motor neuropathy (affecting muscles and movement), and autonomic neuropathy (affecting involuntary functions like heart rate and digestion). Many patients have a combination.
Diabetes is the most common identifiable cause in the U.S. Other causes include nerve compression or injury, alcohol use, medications, toxin exposure, nutritional deficiencies, autoimmune disease, infections, and hereditary conditions. In a quarter to nearly half of cases, no clear cause is ever found.
It often starts mildly with intermittent numbness or tingling in the toes. Left unaddressed, symptoms typically spread further up the foot and leg, become more constant and painful, and may eventually involve muscle weakness, balance problems, and loss of protective sensation.
Diagnosis typically starts with a detailed medical history and physical exam, including sensory testing. Depending on findings, your doctor may order bloodwork to check for diabetes, vitamin deficiencies, or thyroid issues, and may refer you for nerve conduction studies.
It depends on the cause and how early it's addressed. Neuropathy from a reversible factor, like a vitamin deficiency, can sometimes improve significantly once corrected. Neuropathy from long-standing diabetes or unknown causes is harder to fully reverse, but many patients see meaningful improvement with the right plan.
See a doctor if you notice ongoing numbness, tingling, burning, or pain in your feet or hands — especially if it's getting worse, affecting your balance, or you have diabetes. Catching neuropathy earlier generally means more options for slowing its progression.
Our podiatrists in Bethesda, MD and McLean, VA offer thorough evaluations and a systematic regenerative treatment program for peripheral neuropathy.
See Our Neuropathy Treatment Program"I was suffering from neuropathy in both of my feet. I saw multiple doctors for this. Dr. Tran was the only one that could restore the feeling back in my feet."
- Kevin T.
Bethesda, MD
6316 Democracy Blvd
Bethesda, Maryland 20817
(301) 363-2676
McLean, VA
6849 Old Dominion Drive Ste 220
McLean, VA 22101
(301) 363-2676
Monday - Thursday:
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