What can I do about the tingling sensation in my feet to check for neuropathy?

From the Guidelines

You should schedule an appointment with your healthcare provider for a comprehensive foot examination to check for neuropathy, which may include a 10-g monofilament test and other neurologic assessment tools, as recommended by the 2023 standards of care in diabetes 1. To check for neuropathy causing tingling in your feet, your healthcare provider will likely perform a physical examination, test your reflexes, and assess your sensation using tools like a tuning fork or monofilament. Your doctor may order blood tests to check for diabetes, vitamin deficiencies (particularly B12), thyroid function, and other potential causes. Nerve conduction studies or electromyography might be recommended to measure how well your nerves are functioning. In the meantime, you can monitor your symptoms by keeping a diary of when the tingling occurs and what makes it better or worse. Avoid prolonged standing or sitting, wear comfortable shoes that don't compress your feet, and maintain good blood sugar control if you're diabetic. Regular gentle exercise like walking can improve circulation, as shown in a study that found moderate-intensity walking did not lead to an increased risk of foot ulcers or reulceration in those with peripheral neuropathy who used proper footwear 1. It's essential to wear proper footwear and examine your feet daily to detect lesions early, especially if you have peripheral neuropathy. Anyone with a foot injury or open sore should be restricted to non–weight-bearing activities. Neuropathy occurs when peripheral nerves are damaged, often due to conditions like diabetes, vitamin deficiencies, or medication side effects, causing symptoms like tingling, numbness, or pain. Early diagnosis is crucial as some causes of neuropathy can be treated to prevent progression. Some key points to consider include:

• Getting a comprehensive foot examination at least annually, or more frequently for those in higher-risk categories 1
• Using the 10-g monofilament test and other neurologic assessment tools to determine the presence of Loss of Protective Sensation (LOPS) 1
• Maintaining good blood sugar control if you're diabetic to prevent progression of neuropathy
• Engaging in regular gentle exercise, such as walking, to improve circulation 1

From the Research

Tingling Sensation in Feet and Neuropathy

To address the tingling sensation in your feet and check for neuropathy, several steps can be taken:

• A detailed history of symptoms, family and occupational history, and a neurological as well as general physical exam can be conducted, as suggested by 2.
• Pattern recognition of various neuropathies can help to build a differential diagnosis based on the presentation, including acute versus chronic, primary demyelinating versus axonal, hereditary versus acquired, asymmetric versus symmetric, presence of facial palsies, sensory or motor predominant, and presence of prominent autonomic symptoms 2.
• Nerve conduction studies and electromyography (NCS/EMG) can be used as the primary diagnostic tool in the evaluation of patients with large-fiber polyneuropathy, helping to categorize polyneuropathy as primary axonal versus primary demyelinating 2, 3, 4, 5.

Diagnostic Tools

Diagnostic tools that may be used include:

• Nerve conduction studies and electromyography (NCS/EMG) to help categorize polyneuropathy and identify the type of neuropathy 2, 3, 4, 5.
• Laboratory workup, including serum studies and potentially cerebrospinal fluid, genetic studies, immunological markers, and fat pad biopsy for select patients 2.
• Skin biopsy to assess intraepidermal nerve fiber density if small-fiber neuropathy is suspected, and nerve biopsy may be useful in select cases 2.
• Magnetic resonance imaging and neuromuscular ultrasound, which have shown promise in the evaluation of peripheral neuropathy 2.

Importance of Early Diagnosis

Early categorization of the type of neuropathy can help focus the workup for peripheral neuropathy and increase the chances of finding a treatable etiology, as identification of the etiology of neuropathy is crucial and often time-sensitive 2.