FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER'S PERIPHERAL NEUROPATHY FEELS LIKE THICK SOCKS

Question: For the last three years my feet have felt like I had thick socks on, even when I'm barefoot. They also hurt at times. My family doctor said I have peripheral neuropathy and sent me to see a specialist (a neurologist) in the city. He agreed with my family doctor. I've tried several medications, but none have given me much relief. They say I'll just have to learn to live with it, and I guess that is my only choice now. What I don't understand is what caused this and why they can't do more for me. Could you explain peripheral neuropathy so I can understand it?

Answer: The term "neuropathy" tells those accustomed to doctor language that the problem is in the nerves. "Peripheral" refers to involvement of the hands, feet or both rather than areas of the nerves that are closer to the brain and spinal cord. Nerves are very special tissues. I'll try to explain enough about them so that you will be able to understand your condition.

Nerve cells of the brain interpret signals sent to them by other nerves. For the most part, nerves in the spinal cord and the rest of the body either carry signals to the brain for interpretation, or they carry instructions from the brain to the muscles to produce actions. Those which carry signals about the sensations of touch, temperature, pain and the position of body parts to the brain do not work properly in people who have a special type of peripheral neuropathy, called sensory neuropathy, like you have. You see, it is also possible to have difficulty with movement in some types of peripheral neuropathy that attack nerves that control the muscles instead of those controlling sensation.

Your sensory nerves send signals that your brain interprets as the feeling of wearing thick socks, even though you aren't. This is somewhat like having an electrical wiring problem in your house. Think of a light that doesn't turn off when you flip the light switch. Is the problem with the light? That is what you notice it didn't go off when it should have, but the prolem is actually with the switch or in the wiring itself. Your brain interprets the signals it receives as a problem with your feet even though your feet and your brain are fine. The problem is in the sensory nerves themselves, the "wiring" in my analogy.

A neuropathy can be caused by many conditions. A direct injury to a nerve can produce these symptoms in the parts of the body served by that nerve. This type of neuropathy would likely only affect one foot. Neuropathy that affects both feet is more commonly the result of an illness such as diabetes, an inherited disease of the nervous system, a vitamin deficiency, or the side effect of medicines. It can also be caused by lead or other heavy metal poisoning, thyroid problems, alcoholism and several other conditions. I'm confident that your doctor and the neurologist checked for these conditions and just didn't mention this to you.

So what can be done for your pain and unnatural sensations? Pain medicine usually brings some relief, but rarely totally stops the discomfort. Medicines used to treat seizures sometimes give relief. You said in your letter that you have tried medicines of these types without benefit. Unforunately, the medical science of 1996 is just not able to help everyone. Your doctors are probably correct. We can't offer more than support and compassion. We don't yet have a way to regenerate damaged sensory nerves.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.