Peripheral neuropathy, regardless of cause, is a nerve issue. Some damage process, whether that is from diabetes, chemotherapy, autoimmune issues, heavy metal poisoning or some physical damage, hurts the nerves. Since the nerves are responsible for so many things when they are not working, they can cause a variety of symptoms.

But that does not mean it is the cause of all of your symptoms

In our clinic, we see primarily non-compressive peripheral neuropathy patients. But many times there can be other issues going on at the same time. Here is a list of a few:

-Low back issues like sciatica or an irritated nerve root (not always accompanied by acute low back pain)

-Plantar fasciitis

-Bunion

-Balance issues from inner ear or blood pressure problems

-Cellulitis

-Osteoarthritis

-Achilles tendonitis

-Various vascular issues like PAD and symptoms of intermittent claudication

-Pure muscular things like weakness from atrophy or contracture (tightened tissues)

You are entitled to have multiple things going on at the same time!

I would guess that since our average patient age is close to 70 around 20-30% of our patients who come to us for help have a nerve issue with the ends of the nerves as well as some nerve root (by the spine) problem as well.

As I write this this week (It’s only a Tuesday) I have had two patients where their neuropathy symptoms are pretty much under control but they had acute pain, one described it as burning and one as just tight sharp pain, on the outside of one heel.

It’s easy to fall into the trap of thinking there is one cause for everything!

In both cases we did just a little easy mobilization of the heel bone area and they had immediate relief. I showed their significant other (who were with them in both cases) how to do it at home and they both left happy as clams.

Now just doing the mobilization alone wouldn’t have solved their other symptoms of numbness, tingling etc. since there was a foot/ankle structure issue in addition to the neuropathy.

Some clues that I have found helpful in figuring out what combination of things are affecting our patients are listening to the patient history. Testing is useful but a huge part of diagnosis is just listening to the patient. To a competent clinician, Achilles tendon pain and compartment syndrome as described by a patient sound different than peripheral nerve complaints.

Surface area of complaint is a giveaway as well. Things that are generally in a “strip” of symptoms often times can be coming from the low back. So we can have a patient that has a typical axonopathy presentation starting in the toes/balls of the feet and progressing upwards along with a typical L5/S1 dermatomal presentation along the outside of the leg.

See here the L5 nerve root symptoms would follow a “strip” down the outside of the leg in this example. Axonopathy from diabetes, for example, starts at the balls of the feet/toes and hits everything on the way up. They can overlap too!

Thank you to http://www.physio-pedia.com/Sciatica for the dermatome image.

One thing I teach new therapists or clinicians is that with neuropathy there are more “ands” than “ors”. Many times it is X condition AND Y condition that are giving a patient their symptoms.

Timothy Kelm, DC, is one of the clinicians at Realief Medical PA. Since 2007 (or, as he would put it, before you ever saw an advertisement for neuropathy therapy) he has worked with many patients with peripheral neuropathy. He also trains new clinicians for Biolyst LLC, a medical company working for solutions to peripheral nerve damage. He has presented at the University of Minnesota Gynecological Oncology Research Symposium and participated in Tier One research with neuropathy therapy for laser treatment for neuropathy in regards to symptom control. He also lectures in the US to patients on peripheral neuropathy and neuropathy relief. He can be reached by contacting his patient coordinator via email, [email protected] or by phone 952-658-6354.