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Peripheral Neuropathy results from damage to the peripheral nervous system, which is responsible for transmitting information between the brain, the spinal cord, and the rest of the body. Hundreds of types of peripheral neuropathy have been identified, each with a defining set of symptoms. People commonly report numbness, tingling, and a prickly sensations. Others develop an extreme sensitivity to touch, while others develop muscle weakness and muscle wasting. Severe symptoms can include burning pain which is typically worse at night, limb paralysis, and organ or gland dysfunction.

Autonomic Neuropathy is a group of disorders that damage the nerves supplying the internal body structures that regulate numerous ‘automatic’ body functions such as blood pressure, heart rate, sweating, and bowel, bladder, and sexual function. If the cause can be identified and treated, the autonomic nerves may repair or regenerate.

Symptoms may improve with proper treatment. Most symptoms of autonomic neuropathy are uncomfortable but they can be debilitating in severe cases, especially if adequate blood pressure is not maintained while standing (this is called orthostatic hypotension).

There is a large variety of treatment options available for peripheral neuropathy. Some are more successful than others and some are dependent on the causes and type of neuropathy being treated.

Diagnosing Neuropathy can be difficult and can not always be diagnosed by clinical history and exam alone.
Traditionally EMG and NCV studies are utilized to confirm neuropathy, however in the early stages of small fiber neuropathy the most common form of neuropathy that diabetic patients have the NCV studies are often normal.Â

At Dunnellon Podiatry Center, Dr. Witfill often utilizes epidermal nerve fiber density testing to diagnose small fiber neuropathy.
Epidermal nerve fiber density testing (ENFD) is not a new technology, in fact, this technique has been used by neurologists for roughly 15 years. This test takes advantage of the fact that most forms of peripheral neuropathy progress in a distal to proximal fashion, beginning with the body smallest and most distal nerve twigs (C fibers and A delta fibers), and then progressing proximally.

This is why our diabetic patients so often present with peripheral neuropathy in a stocking like distribution. Those that exhibit neuropathy in this pattern, without involvement of large nerve fibers are said to have small fiber peripheral neuropathy. If the nerve pathology progresses proximally to involve larger nerves, the neuropathy becomes mixed.