Often when the nerves start to malfunction (or perform poorly), significant discomfort and pain are encountered.  These symptoms vary widely depending on the type of neuropathy, the nerves affected and even individual tolerances for pain and discomfort. On a regular basis, we discuss these symptoms with patients and hear a wide range of descriptions of how their neuropathy feels:

"Tingling, like the feet are asleep..."

"Cotton between the toes..."

"Ice pick stabbing into the foot..."

"Electrical shooting pains..."

"Like a piece of leather on the bottom of the foot..."

"Numbness, like my foot is wrapped in plastic..."

"Burning, like walking on hot coals..."

"Ice cold..."

"Shooting pains in the toes..."

"Like fire ants biting my feet all over..."

"Overly sensitive to touch, often causing pain..."

These explanations help us to better understand the pain caused by peripheral neuropathy, and break up painful symptoms into two different categories; that of spontaneous pain and that of pain evoked by a stimulus.

Spontaneous Pain

This is pain that is experienced without a reason, without any type of stimulus.  Typically, this type of pain is encountered more at night, or when sitting, and can be very debilitating.  The symptoms may be described as follows:

  • Burning Pain
  • Stabbing Pain 
  • Stinging
  • Freezing
  • Aching
  • Pins and Needles
  • Sharp Pain
  • Feeling of "broken glass"
  • Tightness

Note: Symptoms may present simultaneously in patients, such as burning pain with stabbing pains.

Stimulus-Evoked Pain

This is pain associated with a stimulus, even a simple stimulus.  Common stimuli, that cause pain in individuals with neuropathy include, touching the ground, brushing against bed sheets, wearing shoes, injury,  or pressure to a certain spot of the foot. 

Even when stimuli should cause pain, the associated pain evoked is often uncharacteristic of the stimuli.  This can be described in two ways:

  • Hyperesthesia (Hypersensitivity) - This is an increase in sensation to produce pain with mild stimuli or may cause severe pain with painful stimuli. The pain or sensation is exaggerated for the stimulus received and causes significant. 
  • Paresthesia - This is an abnormal sensation or pain in the skin with or without a stimulus.  This may be pain, but may just be a form of discomfort.

Loss of Function

Although patients often discuss peripheral neuropathy in terms of the painful symptoms it causes, not all symptoms of neuropathy relate to pain. Some of the more problematic symptoms may present as loss of function and may cause:

  • Tremors
  • Muscle weakness (may lead to muscle wasting)
  • Gait imbalance
  • Loss of proprioception (sense of position)
  • Anhidrosis (ability to sweat normally)
  • Decreased manual dexterity
  • Loss of deep reflexes
  • Orthostatic hypotension
  • Poor food digestion
  • Impotence or other sexual dysfunction
Brandt R Gibson, DPM
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Podiatrist, Neuropathy Doctor, Father of 11 and Founder of Mountain West Foot & Ankle Institute