What it is
A short, honest summary.
- —Damage to nerves outside the brain and spinal cord, often from diabetes, autoimmune conditions, chemotherapy, or unknown causes.
- —Symptoms typically start at the feet and hands and move inward (the 'stocking-glove' distribution).
- —Physiotherapy doesn't cure the underlying cause, but it preserves function and prevents falls.
What families notice
The signals worth taking seriously.
- 01Tingling, burning, or numbness in the feet or hands
- 02Loss of balance, especially in the dark or on uneven ground
- 03Foot drop or weakness in the legs
- 04Difficulty buttoning, gripping, or fine motor work
- 05Increased risk of falls or unnoticed foot injury
My approach
How the work is structured.
- —Sensory retraining and balance work — graded, daily.
- —Strength work for the lower limbs to compensate for lost sensation.
- —Foot care education and footwear guidance.
- —Coordination with the treating physician on the underlying cause.
What recovery looks like
A plain-language picture.
“The aim is preservation and adaptation — confidence in walking, safety in the home, and dignity in daily life. Often, sensation returns gradually with the right work.”
FAQ
Common questions, answered briefly.
- Can neuropathy be reversed?
- Some causes (B12 deficiency, early diabetic neuropathy) can improve significantly with treatment. Others are managed rather than reversed.
- How do I prevent falls at home?
- A home assessment looks at lighting, rugs, footwear, bathroom safety, and balance work. Most falls are preventable.
For clinicians
Clinical detail, assessment and evidence.
Clinical summary
The picture in clinician register.
Peripheral neuropathy is dysfunction of peripheral sensory, motor and/or autonomic fibres, most often length-dependent (stocking-glove); diabetic, immune, toxic and idiopathic causes differ in reversibility. Rehabilitation does not alter the underlying lesion but preserves function and prevents falls and unrecognised injury through sensory retraining, strengthening and footwear and foot-care education.
Terminology
Terms worth being precise about.
- Length-dependent distribution
- Symptoms begin in the longest nerves — feet then hands ('stocking-glove').
- Sensory ataxia
- Unsteadiness from loss of proprioception rather than weakness.
- Small- vs large-fibre involvement
- Small-fibre: pain and autonomic; large-fibre: proprioception and strength.
- Foot drop
- Weak ankle dorsiflexion causing toe drag and trip risk.
Assessment & measures
What the first sessions measure.
- —Monofilament and vibration testing.
- —Balance with eyes open and closed (Romberg); functional gait and falls-risk measures.
- —Foot inspection; ankle dorsiflexion strength.
Red flags
Signs that need urgent escalation.
- Rapidly progressive or asymmetric weakness — consider an alternative cause; refer.
- A foot ulcer or an unrecognised injury.
- New autonomic symptoms.
Referral & MDT
When and to whom to refer.
The physician managing the underlying cause (e.g. diabetology). Podiatry for high-risk feet; orthotics for foot drop.
Evidence
References and guideline anchors.
- Balance training and falls in peripheral neuropathy — PLACEHOLDER — verify against current guidelines before launch.