What is the workup for paresthesia (tingling sensation) in the feet?

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Last updated: March 31, 2025View editorial policy

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From the Guidelines

A workup for tingling in the feet should begin with a thorough medical history and physical examination, including assessment of small- and large-fiber function and protective sensation using simple clinical tests such as pinprick, temperature sensation, vibration perception, and 10-g monofilament testing, as recommended by the most recent guidelines 1. The initial evaluation should focus on identifying common causes of tingling, such as diabetic peripheral neuropathy, vitamin deficiencies, and compression neuropathies. Key aspects of the workup include:

  • Medical history to identify risk factors and associated symptoms
  • Physical examination to assess sensory function and identify any musculoskeletal deformities
  • Simple clinical tests to assess small- and large-fiber function and protective sensation
  • Laboratory tests, such as blood glucose and vitamin levels, to identify underlying causes
  • Consideration of other potential causes, including toxins, neurotoxic medications, and systemic diseases, as outlined in recent guidelines 1. The goal of the workup is to identify the underlying cause of the tingling sensation and provide appropriate treatment to improve symptoms and prevent complications, with the most recent and highest quality study guiding the approach 1.

From the FDA Drug Label

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From the Research

Tingling in Feet Workup

  • The workup for tingling in feet involves a comprehensive assessment of potential causes, including diabetic peripheral neuropathy 2, vitamin B12 deficiency 3, 4, 5, and other conditions.
  • Diabetic peripheral neuropathy is a common cause of tingling in feet, and screening for this condition is essential in patients with diabetes mellitus 2.
  • Vitamin B12 deficiency has been linked to peripheral neuropathy, particularly in patients taking metformin for diabetes management 3, 4, 5.
  • Electrodiagnostic (EDX) studies, such as nerve conduction velocity and electromyography, can help guide the diagnosis and treatment of foot pain and tingling 6.
  • A thorough medical history, physical examination, and laboratory tests, including vitamin B12 levels and blood glucose monitoring, are necessary to determine the underlying cause of tingling in feet.
  • Treatment options for tingling in feet depend on the underlying cause and may include medications, such as duloxetine and gabapentin, as well as lifestyle modifications, such as exercise and dietary changes 2, 3.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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