What is the cause of acute neuropathic pain and numbness in the feet, particularly in the toes and ball of the foot, with symptoms worsening when walking barefoot?

From the Guidelines

I strongly recommend continuing to wear proper footwear, such as the compression socks and supportive tennis shoes you have started using, as this is crucial in managing neuropathic foot pain and preventing further complications, as suggested by the most recent study 1. To manage your neuropathic foot pain, it's essential to take a comprehensive approach.

• Start by continuing to wear proper footwear, such as compression socks and supportive tennis shoes, which help reduce pressure on sensitive areas.
• Consider adding a vitamin B complex supplement daily, particularly B1, B6, and B12, which support nerve health and function.
• For breakthrough pain, use acetaminophen 500mg every 6 hours as needed rather than NSAIDs, which may have limited effectiveness for neuropathic pain.
• It's also important to see your healthcare provider promptly for proper diagnosis, as neuropathy can stem from various conditions including diabetes, vitamin deficiencies, or medication side effects.
• Blood tests to check for these underlying causes are essential, and identifying and treating the root cause is crucial for long-term management of your neuropathic symptoms, as emphasized in the recent study 1. Some key points to consider:
• Decreased pain sensation and a higher pain threshold in the extremities can result in an increased risk of skin breakdown, infection, and Charcot joint destruction with some forms of exercise, as noted in 1.
• Moderate-intensity walking may not lead to an increased risk of foot ulcers or reulceration in those with peripheral neuropathy who use proper footwear, as suggested by 1.
• All individuals with peripheral neuropathy should examine their feet daily to detect lesions early, as recommended in 1.

From the Research

Causes of Neuropathy

• Peripheral neuropathies can be caused by vitamin and mineral deficiencies, neurotoxins, and prescription medications 2, 3
• Recognition and prompt treatment of these neuropathies require a high index of suspicion and a detailed history 2
• The peripheral nervous system is susceptible to a broad array of metabolic and toxic abnormalities, which most often lead to a length-dependent sensory-predominant axonal peripheral neuropathy 2

Treatment and Management

• The patient has started wearing compression socks and switched to tennis shoes for more padding to manage symptoms
• Nutritional supplements, such as vitamins B and D, and herbal remedies like curcumin, are being used by patients to self-treat neuropathic pain, but evidence surrounding their efficacy is limited 4
• Vitamin B12 treatment has shown a non-significant association with symptom improvement, while treatment with B1 was associated with a significant improvement in symptoms 5

Role of Vitamins in Neuropathy

• Vitamin deficiency is a risk factor in the development of peripheral neuropathy, and vitamin supplementation may serve as an effective therapeutic strategy 5, 6
• Deficiencies of almost all vitamins are associated with diabetic neuropathy, and vitamins play critical roles in maintaining physiological functions 6
• More clinical trials are needed to establish optimal treatment strategies for vitamins in various neuropathies, and screening for vitamin deficiencies may be considered for early diagnosis and timely medical assistance 6