Burning Feet and Neuropathy —— Causes and Evaluation in Kathmandu

Burning, tingling, or numbness in the feet that persists or worsens over weeks may indicate peripheral neuropathy —— damage to the peripheral nerves that carry sensation and motor signals between the brain and the rest of the body. In peripheral neuropathy, the longest nerves are typically affected first, which is why symptoms usually begin in the feet before potentially progressing to the hands.

What peripheral neuropathy is: The peripheral nervous system includes all nerves outside the brain and spinal cord. When these nerves are damaged, signals become disrupted —— producing numbness, tingling, burning pain, or weakness. Peripheral neuropathy can affect sensory nerves (numbness, pain), motor nerves (weakness), or both. The pattern of involvement —— whether it affects single nerves (mononeuropathy), multiple nerves on both sides symmetrically (polyneuropathy), or randomly scattered nerves (mononeuritis multiplex) —— helps narrow the cause.

Dr. Jitendra Prasad Yadav — consultant neurologist & headache specialist at Kathmandu Neurology Clinic & Cognitive Center provides evidence-based evaluation for peripheral neuropathy.

Common causes: Diabetes is the most common cause worldwide, including prediabetes. Chronically elevated blood sugar damages nerve fibres over time, producing the characteristic glove-and-stocking numbness pattern. Vitamin B12 deficiency is a significant and often reversible cause —— deficiency impairs myelin production, leading to nerve conduction problems. Thyroid dysfunction (both hypothyroidism and hyperthyroidism) can contribute to neuropathy through metabolic disruption. Chronic alcohol use directly toxins nerve tissue and impairs nutritional absorption. Certain medications —— including some chemotherapy agents, metronidazole, isoniazid, and high-dose vitamin B6 —— can cause nerve damage. Kidney disease, autoimmune conditions, and hereditary factors also contribute.

How neuropathy is evaluated: Evaluation begins with a detailed history —— onset, distribution, duration, associated symptoms, and exposure to risk factors. Clinical examination tests sensation (light touch, pinprick, vibration, position sense), motor strength, reflexes, and gait. Blood tests commonly include HbA1c or fasting glucose (to detect diabetes or prediabetes), vitamin B12 level, thyroid function, and kidney function. Nerve conduction studies (NCS) and electromyography (EMG) measure the electrical activity of nerves and muscles, helping characterise the type and severity of neuropathy —— whether axonal (nerve fibre damage) or demyelinating (sheath damage). These tests are ordered when the clinical picture is uncertain or when the result will change management.

Management approaches: Treatment addresses the underlying cause where possible —— optimising glucose control, replacing B12 if deficient, correcting thyroid dysfunction, and reducing or stopping offending medications. Symptom management includes medications for neuropathic pain (such as pregabalin, gabapentin, duloxetine, or amitriptyline), topical treatments for local symptoms, and physical therapy for balance and strength. Foot care is essential —— proper footwear, daily foot inspection, moisturising dry skin, and prompt treatment of cuts or sores reduce the risk of complications.

When to seek care: Seek prompt evaluation for rapidly progressive weakness, numbness that is spreading upward the legs or to the hands, bladder or bowel dysfunction, or pain so severe it limits walking. Early evaluation allows identification of reversible contributors before permanent nerve damage occurs.

Dr. Jitendra Prasad Yadav (NMC 8029) evaluates peripheral neuropathy systematically at Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, Opposite of Yak & Yeti Hotel.

This article is educational and does not replace individual medical advice.