In the vast majority of cases, the following symptoms occur, starting distally at the lower extremities: When the symptoms occur, there are symmetrical and asymmetrical distribution patterns, which partly indicate the cause of the polyneuropathy. Symmetrical: Most common type with glove- and stocking-shaped sensitivity disorders and distal reflex weakening and/or paralysis.
- Pain
- Sensory disturbances, disturbances of the sense of touch (sensitivity disorders), nocturnal sensations in the area of the toes or soles of the feet
- Unpleasant temperature sensation
- Tormenting tingling or formication
- Burning of the feet, especially the soles of the feet (“burning feet”)
- Sock- or glove-shaped loss of sensitivity (“walking like on socks”)
- Reduced or missing sense of vibration
- Missing Achilles tendon reflex
- Paralysis of the muscles on the back of the foot, so that spreading the toes is no longer possible and the tip of the foot gets stuck when walking
- Later, additional sensitivity disorders and paralysis in the hands and arms (upper extremities)
- Short-lasting unconsciousness (syncope) and bladder disturbances
- Dizziness, gait insecurity
- Disturbances of the cranial nerves
Asymmetrical: There are three different types:
- In a mononeuropathy, only disorders in the supply area of a peripheral nerve can be detected.
- In mononeuropathia (mononeuritis) multiplex (multiplex type), disturbances in the supply areas of several peripheral nerves can be recognized, but the adjacent nerves are hardly or not at all affected.
- The focal neuropathy is a combination of mononeuropathy multiplex and a symmetrical polyneuropathy.
Symptoms on the feet
Often the feet and also the legs are the place where polyneuropathy first becomes symptomatic. Polyneuropathy becomes apparent very early, especially on the toes. In addition to the possible symptoms already mentioned, such as sensations in the form of tingling or numbness, insecurity of gait and dizziness are typical of polyneuropathy of the feet.
and Burning feet This occurs particularly in the dark and can be explained by the fact that, in addition to the sense of balance, vision and perception of the position of the extremities in space, the so-called proprioception, play a role in the vestibular system. Proprioception is mediated by the nerves in the extremities, which provide the brain with information about the position of the arms and legs. In polyneuropathy, it is often precisely these nerves that are damaged, which means that this component of the balance system functions only to a limited extent or even no longer at all.
If the visual system is then switched off by darkness, the vestibular system can no longer function properly, resulting in dizziness and insecure gait, which can manifest itself in falls. A further symptom that can be characteristic of polyneuropathy of the feet is what is known as allodynia, i.e. a painful reaction to a stimulus that is perceived as not painful in healthy people. For example, just putting on socks or shoes can cause severe pain.
This symptom often occurs in polyneuropathy triggered by diabetes mellitus, which is why there are the typical “diabetic feet”, which are seriously damaged by unnoticed injuries and inflammation and sometimes even have to be amputated. Also typical of diabetic polyneuropathy of the feet is a burning pain on the sole of the foot, which is called “burning feet“. These sensations usually worsen at night.
Damage to motor nerves, which are actually responsible for the movement of the muscles of the feet and legs by stimulating them, can lead to weakness of the feet, rapid muscular fatigue and loss of strength. This can even be measured objectively if the reduced excitation of the muscles leads to their breakdown (atrophy) and the affected person gets very thin legs. Another objective method for detecting polyneuropathy is the loss of specific reflexes in the foot.
This symptom often occurs in polyneuropathy triggered by diabetes mellitus, which is why there are the typical “diabetic feet”, which are seriously damaged by unnoticed injuries and inflammation and sometimes even have to be amputated.Also typical for diabetic polyneuropathy of the feet is a burning pain on the sole of the foot, called “burning feet“. These sensations usually worsen at night. Damage to motor nerves, which are actually responsible for the movement of the muscles of the feet and legs by stimulating them, can lead to weakness of the feet, rapid muscular fatigue and loss of strength. This can even be measured objectively if the reduced excitation of the muscles leads to their breakdown (atrophy) and the affected person gets very thin legs. Another objective method for detecting polyneuropathy is the loss of specific reflexes in the foot.
All articles in this series:
