Background &Etiology
The foot is responsible for supporting the weight of the body, while enabling us to walk, run, and move smoothly with speed and precision. There are five major nerves of the lower leg that affect the foot: the sural nerve, the saphenous nerve, the posterial tibial nerve, the deep peroneal nerve and the superficial peroneal nerve. These nerves provide both sensation and motor control to the foot.
Peripheral Neuropathy
The peripheral nerves are a network through the body that connects the brain and spinal cord with muscles, skin and internal organs. Peripheral nerves originate in the spinal cord and extend out into the body. Damage to these nerves restricts communication between the brain and the part of the body the nerves serve. In the case of the foot, peripheral neuropathy can affect normal sensation and movement, and cause pain, tingling and loss of feeling.
Mononeuropathies
When a single peripheral nerve is affected, the condition is called a mononeuropathy. One of the most common mononeuropathies in the lower extremity is peroneal nerve palsy. In this condition the nerve at the top of the calf, behind the knee is compressed. This is a common cause of foot drop.
There are different kinds of peripheral neuropathy with varied causes. These can range from compression (as is seen in conditions like tarsal tunnel syndrome) to more severe traumatic injuries that cause paralysis. Common causes of peripheral neuropathy include:
- Diabetes
- Nerve damage in the spine, or in the legs and foot
- Compression to the peripheral nerve following an injury or trauma
- Poor nutrition or vitamin deficiency
- Certain medications
- Hereditary neuropathies (passed down from family members)
- Idiopathic neuropathies (the cause is unknown). As many as 1/3 of all neuropathies are idiopathic.
- Infections
- Metabolic disorders
- Alcoholism
- Tumors
- Loss of sensation in the foot
- Tingling, numbness, or a feeling of “pins and needles” in the foot
- Difficulty moving the foot in response to nerve cues
- Difficulty walking or performing daily tasks
- Deep aching pain in some instances that is worse at night.
- Weakness and possible diminished reflexes
- Gait abnormalities
- Loss of coordination
The treatment for peripheral neuropathy will depend on the underlying condition that has caused the nerve dysfunction. If an individual suspects they have neuropathy, the initial treatment should consist of avoiding the positions and activities that produce the pain. A course of conservative treatment is usually recommended that would include rest, ice, hand therapy and non-steroidal medications to reduce inflammation. If symptoms persist, treatment by your physician may be necessary. This may include steroidal medication, pain medication, TENS, in conjunction with therapy. Surgery for peripheral neuropathy may be considered in extreme cases to take pressure off the involved nerve.
Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of Peripheral Neuropathy include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, and manual stretching by a hand therapist to regain mobility and range of motion of the foot and lower leg.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the leg and effected muscle.
- Neuromuscular Reeducation (NMR) to restore stability, retrain the upper extremity, and improve or modify movement technique and mechanics (for example, running, stepping, or jumping) in daily use of the involved lower extremity. Sensory stimulation for sensitizing or desensitizing affected area as appropriate.
- Modalities that can include the use of ultrasound, electrical stimulation, TENS, ice, cold laser and others to decrease pain and inflammation at the foot, ankle, and leg.
- Home program that includes splinting, strengthening, stretching and stabilization exercises and instructions/modifications to help the person perform daily tasks and advance to the next functional level.
Procedures that your physician may recommend and perform in addition to physical therapy that include:
- REST and ICE
- The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
- TENS Transcutaneous Nerve Stimulation for pain
- Steroidal injections to reduce inflammation
- Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
- Prescription for Physical Therapy
- Surgery in the case of a condition that may be compressing the effected nerves.
Prognosis
Prognosis for this condition depends on the cause of the neuropathy. The best way to prevent peripheral neuropathy is to carefully manage and medical conditions that may put you at risk.
