The Five Stages of Neuropathy

Dr. Robert Parker
Connect with me
Dr. Parker is a podiatrist and surgeon in Houston, TX who has been helping patients for more than 40 years.

If you’ve followed our blogs—or you suffer from the condition yourself—you probably already know that peripheral neuropathy isn’t static. Instead, it’s a progressive condition.

What that means is that, if you don’t take the appropriate measures to treat it, it’s going to keep getting more and more severe.

But neuropathy doesn’t just “get worse” in the same way that, say, a bunion becomes more pronounced or gout attacks become more frequent. The actual nature of the symptoms change over time as the nerves become progressively more damaged.

What does that actually look like in practice? And what does each stage mean for you, and your future?

Typically, we chart the course of the disease in five separate stages.

The First Stage: Intermittent Pain and Numbness

In this stage, you’ll start to notice the earliest signs that something may not be totally right with the nerves in your feet.

The symptoms may be subtle, or only occur quite rarely. You may have brief episodes of unexplained foot pain, but go weeks or even months between them.

Alternatively, your feet may feel like they’re very slightly numbed—as if you’re wearing a thin, barely-noticeable stocking even when you’re barefoot. (You might be more likely to notice this sensation at night, with the feel of the bedsheets against your skin.)

Your reflexes and balance will also probably suffer, but not necessarily in a way that you might notice on your own.

One important thing to note here is that, while stage 1 neuropathy is most often caused by excess sugar consumption, most people actually don’t yet have a diabetes diagnosis at this stage, and in fact a fasting blood sugar test may come back normal. A fasting serum insulin test, however, typically reports worse news.

What’s the prognosis?

Stage 1 neuropathy can almost always be fully reversed without requiring advanced treatments from our office. But what it does require is that you significantly alter your diet by cutting out carbs, sugar, junk food, and other high glycemic foods.

For more information on the link between diet and neuropathy, read this informative blog post.

We also have a free downloadable beginner’s guide to cutting sugar and making healthier diet choices. You can request a free copy by clicking here and providing an email address where we can send the guide.

The Second Stage: More Constant Pain

The line between stage 1 and stage 2 isn’t clearly defined. But what you will notice, as you move from the former into the latter, is that your episodes of pain are getting more intense and occurring more frequently—although they are still intermittent.

In other words, while you might have been able to ignore or shrug off some of the early warning signs, in phase 2 that position becomes more and more difficult to maintain. By now, you (hopefully) have made an appointment with us and/or your primary care physician, and you may have even had blood sugar issues (prediabetes or diabetes) diagnosed.

What’s the prognosis?

You’re really at the precipice here.

In stage 2, your neuropathy is likely still fully reversible through a combination of dietary changes and advanced treatments from our office. But you’re also at the point where, if you let it get any worse, your risk of developing permanent, potentially life shattering complications starts to skyrocket.

Stage 2 is your last “safe” (relatively speaking) chance to reverse course before neuropathy becomes significantly more dangerous, expensive, and difficult to treat.

The Third Stage: The Height of Pain

In stage 3, your pain symptoms are essentially constant (or at least every day), and probably the worst they are going to get.

Your lifestyle has probably been significantly impacted by your pain, and there’s a good chance that you’re taking a whole slew of medications to partially control your symptoms. (To the extent that they even work, they’re probably also producing side effects like dizziness, fatigue, and potentially even depression.)

But the pain itself is only part of the issue. Because your nerves aren’t communicating as well with your brain anymore, it’s not a guarantee that you’ll even notice injuries that occur to your feet. Cuts and blisters can start to fester—and because your immune system will also be compromised, those “minor” injuries can develop into major ulcers.

Ulcers are the leading cause of non-traumatic amputations in the lower limbs and, if infections aren’t controlled, there’s a major risk we’ll have to remove part of your limb to stop it. And even if we do manage to save your feet, the process is still going to be time consuming, expensive, painful, and disruptive.

What’s the prognosis?

Even in stage 3, there’s still a chance we may be able to reverse a majority of the nerve damage and restore mostly healthy nerve function—if you immediately and radically overhaul your diet, and begin our advanced neuropathy solutions breakthrough program (which includes treatments such as electronic nerve stimulation, chemical nerve blocks, therapeutic laser treatment, and more.)

But as you can see, it’s really now a matter of life and death. It won’t take much to cause an injury that could claim your feet, or your life (through gangrene, sepsis, etc.)

The Fourth Stage: Numbness Starts to Set In

As you pass from stage 3 to stage 4, you’ll begin to notice that your pain is starting to decline—or perhaps you’re beginning to experience intermittent episodes of significant pain relief.

Since we as humans are conditioned to think of limiting pain as the ultimate goal, stage 4 can almost feel like a relief. But the truth is much sadder.

The reason symptoms are improving is because, essentially, your nerves are starting to more or less disintegrate. The small fibers are almost completely gone, and now even the large fibers (which are primarily responsible for proprioception and sensing touch and vibration) are starting to go.

In the moment-to-moment, sure, you might feel better. But numbness is making it increasingly difficult to walk and balance properly, and if you have diabetes you will probably start to develop other complications like retinopathy or kidney failure (if you haven’t already). And of course, the risk of major foot-related complications (ulcers, amputations, sepsis) continue to rise at alarming rates.

What’s the prognosis?

In stage 4, the recommendation is basically the same as it is in stage 3—change your diet and begin treatments.

The difference is that, by stage 4, much of the damage you’ve already done to your nerves is not reversible. Treatments are still important, as they will still improve your symptoms, lower your complication risks, and help you participate safely in many activities you used to enjoy. But at this point, there’s no going all the way back.

The Fifth Stage: Total Loss of Sensation

If you make it to stage 5, your nerves are now so shot that you don’t feel any pain at all. The link to the brain has been severed.

As you can imagine, your risk of ulceration, amputation, and all the related complications that surround it are at their absolute highest. Balancing and walking on steady feet become extremely difficult. Your mobility will be limited. You may be in a wheelchair. You won’t be able to drive a normal car, since you can’t feel the pedals with your feet.

What’s the prognosis?

At this point, the chance to restore full function to your nerves is long past.

That said, all hope is not lost. Although you will almost certainly be suffering from the effects of neuropathy for the rest of your life and will have to take extremely good care of your feet, a full-court press using all the treatments at our disposal may help you regenerate some small nerve fibers and restore enough function to return to some of your previous activities.

This may include the previously mentioned electrochemical and laser therapies, as well as further regenerative medicine therapies (such as stem-cell derived growth factor treatments using amniotic and umbilical tissue.)

Houston’s Leader in Neuropathy Care

As we hope we’ve demonstrated, each new stage of peripheral neuropathy you enter makes your life harder, makes treatment more difficult, and increases your risk of serious (and potentially fatal) complications.

Yes, advanced medical treatments are advancing all the time and can offer healing and restoration at previously unprecedented rates. But the truth is that you should always do everything in your power to get off this debilitating neuropathy train at the earliest possible stage you can.

So if you begin to notice the creeping signs of pain or tingling in your feet, don’t wait. Get help from Houston’s peripheral neuropathy expert, Dr. Robert Parker. From dietary coaching to the most advanced regenerative treatments available, we can help you no matter what stage you’re in—but the earlier, the better.

Schedule an appointment with us today by calling our office at (281) 497-2850.

Be the first to comment!
Post a Comment