Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Electrodiagnostic testing — nerve conduction studies (NCS) and electromyography (EMG) — is the gold standard for objectively documenting peripheral nerve pathology in the lower extremity, including tarsal tunnel syndrome, peroneal nerve palsy, peripheral neuropathy, and suspected radiculopathy. Understanding what the test involves and what findings mean helps patients prepare for the evaluation and interpret their results.

What NCS and EMG Measure

Nerve conduction studies (NCS): surface electrodes apply a small electrical stimulus to a peripheral nerve at one point and record the time for the signal to travel to a recording electrode at a known distance — measuring conduction velocity (how fast the nerve conducts) and amplitude (how many nerve fibers are conducting). Slowed conduction velocity indicates demyelination (the insulating myelin sheath is damaged); reduced amplitude indicates axonal loss (nerve fiber death). In tarsal tunnel syndrome, slowed medial or lateral plantar nerve conduction velocity and prolonged distal latency are characteristic findings. In diabetic peripheral neuropathy, all distal sensory nerves show reduced amplitudes and slowed velocities in a length-dependent (stocking-distribution) pattern. Electromyography (EMG): a fine needle electrode is inserted into individual muscles to record electrical activity at rest and during voluntary contraction. Normal muscle is electrically silent at rest; denervated muscle shows spontaneous activity (fibrillations, positive sharp waves) — indicating nerve injury to that muscle’s motor nerve supply. EMG localizes which specific muscles are affected to determine the level of the nerve lesion (root vs. plexus vs. peripheral nerve).

Clinical Applications in Foot and Ankle

Tarsal tunnel syndrome: NCS may show delayed medial and/or lateral plantar nerve latencies, reduced plantar nerve sensory amplitudes, and abnormal abductor hallucis or abductor digiti minimi EMG. Peroneal nerve palsy/foot drop: NCS shows peroneal motor conduction slowing or block at the fibular head; EMG shows denervation in tibialis anterior and peroneal muscles. Peripheral neuropathy workup: NCS objectively quantifies severity and determines whether predominantly sensory, motor, or mixed — important for treatment planning and disability assessment. Radiculopathy (L4–S1): paraspinal muscle EMG abnormalities at specific levels differentiate root-level from peripheral nerve pathology. Dr. Biernacki at Balance Foot & Ankle coordinates electrodiagnostic testing for patients with suspected tarsal tunnel syndrome, neuropathy, or foot drop. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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Frequently Asked Questions

What is the best treatment for peripheral neuropathy in the feet?

Treatment depends on the cause. For diabetic neuropathy, blood sugar control is most important. Other options include B12 supplementation, MLS laser therapy, topical creams (capsaicin, lidocaine), and prescription medications like gabapentin or duloxetine. Our podiatrists tailor treatment to each patient’s specific type and severity.

Can neuropathy be reversed?

In some cases — particularly when caused by vitamin deficiencies or early-stage diabetes with good glucose control. However, long-standing nerve damage is often permanent. Treatment focuses on slowing progression, managing symptoms, and preventing dangerous foot complications like ulcers.

How often should I see a podiatrist if I have neuropathy?

Patients with peripheral neuropathy should have comprehensive foot exams every 3–6 months, or more frequently if they have diabetes, poor circulation, or a history of foot ulcers.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.

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Nerve Testing (NCS/EMG) for Foot & Ankle Conditions

Nerve conduction studies and EMG testing help pinpoint the cause of foot numbness, tingling, and weakness. Our podiatrists use electrodiagnostic results to guide treatment decisions for neuropathy, tarsal tunnel syndrome, and radiculopathy affecting the feet.

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Clinical References

1. Oh SJ. Clinical Electromyography: Nerve Conduction Studies. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2003.
2. Patel AT, Gaines K, Malamut R, Park TA, Del Toro DR, Holland N. Usefulness of electrodiagnostic techniques in the evaluation of suspected tarsal tunnel syndrome. Arch Phys Med Rehabil. 2005;86(10):2000-2007.
3. England JD, Gronseth GS, Franklin G, et al. Practice parameter: evaluation of distal symmetric polyneuropathy. Neurology. 2009;72(2):177-184.