Axonal peripheral neuropathy

Around 10% of people over the age of 55 are estimated to have peripheral neuropathy, and most cases are axonal in nature. Peripheral neuropathy refers to the degeneration of the peripheral nerves responsible for transmitting signals to the limbs. When the neuropathy is axonal, the damage occurs specifically to the nerve fibre itself (the axon).

There are many possible causes, but common ones include diabetes, long‑term alcohol use, chemotherapy, vascular problems, and nutritional deficiencies. The condition often follows a “dying‑back” pattern, where the most distant parts of the nerves are affected first. As a result, symptoms usually begin in the fingers and toes before gradually progressing up the limbs.

Unfortunately, these symptoms rarely improve, and for many people they gradually worsen over time.

Common symptoms:

• Sensory changes- this can be both loss of sensation, hypersensitivity (allodynia) or changes to sensation e.g burning sensation, tingling, electric shocks etc. 
• Increased chance of injury, particularly if sensitivity to temperature is affected 
• Distal muscle weakness causing things like drop foot
• Impaired balance, both due to impaired sensation and weakness around the ankle 
• Reduced dexterity in your hands
• Increase in muscle cramps 
• Alterations to walking, loss of heel toe pattern, often have a high stepping gait
• Increased falls rate both due to loss of balance and increased likelihood of tripping 

Physiotherapy management:

• Strengthening work to sustain current strength, allow for better compensation and in some cases you can partially strengthen affected areas 
• Work on balance- Typically this is the biggest reason people with peripheral neuropathy see me if their balance has deteriorated and they are falling 
• Work on walking pattern, trying to achieve heel strike if possible
• Providing with compensatory orthotics for people who have significant weakness unlikely to improve