Diagnosis of patients with peripheral nerve disease

Podiatrists have a unique opportunity to detect neuropathies at stages where specific treatment and measures to limit progression may be most beneficial. This article reviews neuropathic symptoms and signs that call for timely neurologic evaluation and intervention and outlines the essentials of a focused evaluation. The detailed clinical history and examination are still the mainstays for determining the specific diagnosis of most neuropathies and for distinguishing other neurologic disorders that may mimic neuropathies. Whenever the cause, severity, or very presence of a neuropathy remains uncertain, electromyography and nerve conduction studies performed by a well-trained physician experienced with neuromuscular diseases should be the mandatory next steps. Clinicians should expect electrophysiologic studies to define the specific pattern of neuropathy (fiber-length dependent versus multifocal) and the predominant pathologic process (axon loss versus demyelination), enabling them to restrict diagnostic tests to a rational, necessary, cost-effective, and productive minimum.