Nerve damage in the hands and feet has many causes. Several of them can be treated. A free check that works out which tests you actually need.
Peripheral neuropathy means the nerves running to your hands and feet are not working properly. It usually starts in the toes. It then creeps upwards over months or years. Doctors call the pattern gloves and stockings.
It can feel like burning. It can feel like walking on gravel. It can feel like your feet are wrapped in cotton wool. Or it can feel like nothing at all. Feet you cannot feel properly put you at risk of falls, and of injuries you never notice.
Weakness that starts in your feet and climbs up your legs over hours or days can be Guillain-Barré syndrome. It can reach the muscles you breathe with, and it can do that fast.
Call 999 if you are short of breath or struggling to swallow. This can be treated. Treated early, the outlook is much better. Do not wait for a routine appointment.
Source: NICE CKS Neuropathy (Guillain-Barré syndrome) · NICE NG128
Do it now. Every minute makes a difference.
Diabetes is the most common cause of nerve damage in this country. It can also be the first sign that blood sugar has been high for a while. That includes people who did not know they had diabetes at all.
So everyone assessed on this pathway has an HbA1c blood test. It shows your average blood sugar over about three months.
Getting blood sugar under control is the main treatment. It rarely undoes damage already done. But it does slow things down.
Source: NICE NG19 (diabetic foot problems) · NICE CKS Neuropathy
Low vitamin B12. This is common in people taking metformin, and in people on long-term stomach acid tablets. It is also common if you eat little or no animal food. It is treated with injections or tablets.
An under active thyroid. Simple blood test, simple treatment.
Alcohol. Regular heavy drinking damages nerves directly and also causes vitamin deficiencies.
Chemotherapy. Several chemotherapy drugs damage nerves. Say so if your symptoms began during or after cancer treatment. It changes what happens next.
Autoimmune conditions. Sjögren’s syndrome and vasculitis can both inflame nerves. These need different treatment from the causes above.
Kidney disease, and some infections, can also be responsible.
Source: NICE CKS Neuropathy — investigation of peripheral neuropathy
Nerve conduction studies measure how fast and how strongly signals travel along your nerves. Small electrical pulses are used. Most people find this uncomfortable rather than painful.
EMG involves a fine needle placed into a muscle to listen to its electrical activity.
Together they show which nerves are affected, and how badly. They also show whether the problem is the nerve fibre itself or its outer coating. That answer shapes the whole treatment plan.
Sometimes the standard tests come back normal even though your symptoms are real. A small skin sample can then pick up small fibre neuropathy, which the usual tests miss.
Source: NICE CKS Neuropathy — nerve conduction studies and EMG
Medicines that can cause it, and medicines that treat the pain
Some medicines cause nerve damage. Topiramate, used for migraine and epilepsy, often causes tingling in the hands and feet. Several chemotherapy drugs can do it. So can amiodarone for heart rhythm, and long courses of some antibiotics.
If a medicine is the cause, no scan will help until that is sorted out. So the check reviews what you are taking before it suggests any test.
For nerve pain itself, NICE recommends starting with amitriptyline, duloxetine, gabapentin or pregabalin. Ordinary painkillers such as paracetamol and ibuprofen do not work well on nerve pain.
Do not start or stop any medicine because of this page. That is a decision for your prescriber.
Source: NICE CG173 (neuropathic pain in adults) · BNF
If you cannot feel your feet, you will not feel a blister. You will not feel a stone in your shoe, or a burn from a hot bath.
Look at both feet every day, including the soles and between the toes
Check inside your shoes with your hand before putting them on
Test bath water with your elbow, not your foot
Never use a hot water bottle against bare feet
Get any break in the skin looked at quickly — do not wait to see if it settles
Source: NICE NG19 (diabetic foot problems — prevention and management)
We ask about mood, memory, motor skills, and sensory changes to tailor your diagnosis and treatment.
Video appointments start at £349. They include HbA1c, B12, thyroid and full blood count tests. Silver adds nerve conduction studies and EMG. In-person appointments start at £799 and include a full neurological examination.