Neurological Foot and Ankle Disorders

What are neurological foot and ankle disorders?

Neurological foot and ankle disorders happen when damage, pressure or disease affecting your nervous system disrupts the feeling or movement in your feet and ankles. The problem may sit in the nerves of your foot or ankle itself, or come from a wider condition affecting your brain, spinal cord or nerves elsewhere in your body.

What are the symptoms of neurological foot and ankle disorders?

Symptoms vary depending on which nerves are affected and what's causing the problem, but common signs include:

• tingling, numbness, burning or shooting pain in your feet or ankles
• muscle weakness, or a foot that drops or drags when you walk
• loss of sensation, meaning you might not notice an injury, blister or cut on your foot
• an unsteady or abnormal way of walking, or problems with balance and coordination
• muscle stiffness or spasms
• changes in the shape of your foot or toes, such as a high arch or curled toes.

What are the causes of neurological foot and ankle disorders and who is at risk?

These disorders can have many different causes:

• Diabetes: The most common cause of peripheral neuropathy
• Autoimmune disease: Infections or vitamin deficiencies
• Alcohol: This can damage nerves over time
• An inherited condition: Such as Charcot-Marie-Tooth disease
• A wider neurological condition: Such as multiple sclerosis, Parkinson's disease, stroke or cerebral palsy
• Injury: Repeated pressure, or swelling that compresses a nerve in your foot or ankle, known as nerve entrapment.

You may be more at risk if you have poorly controlled diabetes, drink alcohol heavily, have an autoimmune condition, or have previously injured your foot or ankle.

Are there different types of neurological foot and ankle disorders?

This is an umbrella term covering several distinct conditions:

• Peripheral neuropathy: Damage to the nerves that carry sensation to and from your feet, often caused by diabetes, autoimmune disease, infection or vitamin deficiencies
• Tarsal tunnel syndrome: Compression of the tibial nerve as it passes through a narrow tunnel in your ankle, causing pain, burning or numbness in your heel or sole
• Baxter's nerve entrapment: Compression of a nerve running across the bottom of your foot, causing numbness and pain in your heel and sole
• Peroneal neuropathy (foot drop): Damage to a nerve just below your knee, making it hard to lift your foot or toes
• Morton's neuroma: Thickening of a nerve, usually between your third and fourth toes, causing pain and burning in the ball of your foot
• Charcot-Marie-Tooth disease: An inherited condition affecting the nerves that control your muscles, leading to weak legs, an abnormal gait and foot deformities
• Foot and ankle symptoms caused by a wider neurological condition: Such as multiple sclerosis, Parkinson's disease, stroke or cerebral palsy.

How are neurological foot and ankle disorders diagnosed?

Diagnosis starts with your medical history and a physical examination of your feet, ankles and the way you walk. Your doctor will use your symptoms, along with targeted tests, to work out the specific cause and the best treatment plan for you.

How are neurological foot and ankle disorders treated?

Non-surgical treatment

Treatment depends on the underlying cause, but often combines several of the following approaches:

• Medication to manage pain, muscle spasms, or the underlying condition
• Physiotherapy or occupational therapy, to maintain strength, movement and balance
• Orthotics, braces or walking aids to support your foot and ankle
• Rest, icing, massage or cortisone injections for nerve compression
• Changes to your footwear or activity levels.

Surgical treatment

If non-surgical treatment doesn't relieve your symptoms, surgery may help with some conditions. This can include releasing a trapped nerve, such as in tarsal tunnel syndrome, or removing a thickened nerve, as in Morton's neuroma. Some foot deformities linked to these conditions can also be corrected surgically.

For some underlying conditions, such as Parkinson's disease, deep brain stimulation surgery is sometimes used. There's no cure for conditions such as Parkinson's disease or Charcot-Marie-Tooth disease, so treatment aims to manage symptoms rather than cure the underlying condition.

When should I see a doctor?

See a doctor if you notice ongoing numbness, tingling, weakness, or unusual pain in your feet or ankles that isn't explained by an obvious injury. This is especially important if you have diabetes, since numbness can hide an injury or infection until it becomes serious.

Getting a prompt diagnosis and starting treatment early can help prevent symptoms from becoming permanent.