How does peripheral neuropathy affect balance and walking?

What is peripheral neuropathy?

Peripheral neuropathy is damage to the nerves outside the brain and spinal cord. The longest nerves, which run to the feet, are usually affected first, so symptoms often begin in the toes and soles and can later spread up the legs and into the hands. People describe numbness, tingling, burning pain, a feeling of walking on cotton wool, or cramps.

Common causes include diabetes, excess alcohol, vitamin B12 deficiency, an underactive thyroid, kidney disease, some chemotherapy drugs and inherited nerve conditions. In some people no cause is found. Identifying and treating the cause can slow further damage.

Why does neuropathy make balance worse?

Balance depends on three sources of information: vision, the inner ear balance organs, and position sense from the joints and soles of the feet. Neuropathy reduces position sense, so the brain has less information about body position and ground contact. The person compensates by relying more on vision and on watching their feet.

This works in good light on flat surfaces but fails in the dark, on uneven or soft ground, or when the eyes are closed, such as when washing the face or hair. Weakness of the small foot and ankle muscles, which can also occur in neuropathy, adds to unsteadiness.

How does neuropathy change walking?

People with neuropathy often walk more slowly with shorter steps and a wider base, and they may watch the ground constantly. If the muscles that lift the foot are weak, the toes can catch, causing trips. Reduced sensation means minor injuries, blisters or badly fitting shoes may go unnoticed.

Painful neuropathy can also change walking, as people avoid putting weight through painful areas. Fear of falling may lead to less walking, which reduces strength and fitness and further increases fall risk.

Which exercises help?

Exercise programmes that include balance and functional training reduce falls in older people living in the community, and programmes combining several types of exercise are also effective 2. For neuropathy, balance exercises that gradually challenge standing and stepping, such as standing with feet closer together, heel-to-toe standing near a support and stepping in different directions, are useful.

Strengthening the hip, knee and ankle muscles, practising getting up from a chair and walking programmes improve stability. Tai chi and similar activities train weight shifting and posture. A physiotherapist can set safe exercises and progress them.

How can falls be prevented?

Falls prevention guidance recommends assessing individual risk factors, including neuropathy, balance, strength, vision, medicines, low blood pressure on standing and home hazards, and then addressing each 1. Good lighting, especially night lights between bedroom and bathroom, rails on stairs and in the bathroom, and removing loose rugs are simple steps.

Supportive, well-fitting shoes with thin, firm soles provide better ground feel than soft slippers. A walking stick can add information through the hand about the ground and improve stability on uneven surfaces. Reviewing medicines that cause drowsiness or dizziness also reduces risk.

How important is foot care?

Reduced sensation means injuries can go unnoticed and become infected, especially in diabetes. Checking the feet daily, including between the toes and the soles using a mirror, keeping skin moisturised but not between the toes, cutting nails carefully and seeing a podiatrist regularly help prevent problems.

Testing bath water with the elbow or a thermometer, avoiding walking barefoot and checking shoes for stones or rough seams before wearing are practical habits for people with numb feet.

How is painful neuropathy treated?

Nerve pain may respond to specific medicines rather than standard painkillers. For painful neuropathy caused by chemotherapy, guidance identifies duloxetine as the only medicine with appropriate evidence to support its use, although the benefit is limited 3. Other medicines may be used for neuropathy from other causes, depending on side effects and other conditions.

Non-drug approaches such as exercise, sleep management and psychological strategies for coping with pain can support medication. Treating the underlying cause, such as improving blood sugar control in diabetes, remains important.

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