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

Peripheral neuropathy — damage to the peripheral nerves causing numbness, tingling, burning, and pain in the feet — affects over 20 million Americans, with diabetes being the most common underlying cause. While there is no cure for most neuropathies, significant symptom management is achievable with the right treatment combination. Here is an honest review of current options and what the evidence shows.

Treating the Underlying Cause First

Before addressing symptoms, the underlying cause must be identified and treated where possible:

• Diabetic neuropathy — optimal glycemic control (target HbA1c <7%) remains the most powerful intervention for slowing progression; some patients experience symptom improvement with better sugar management
• Vitamin B12 deficiency neuropathy — B12 supplementation or injection is highly effective when deficiency is the cause; improvement takes months
• Alcoholic neuropathy — abstinence from alcohol, combined with B-vitamin supplementation, can produce significant improvement
• Hypothyroid neuropathy — thyroid hormone replacement resolves neuropathy over months in most cases

Symptomatic Treatment Options

First-Line Medications

• Gabapentin (Neurontin) — reduces neuropathic pain by modulating calcium channels; start low (100–300mg nightly), titrate to effect; sedation and weight gain are common side effects
• Pregabalin (Lyrica) — similar mechanism; FDA-approved for diabetic peripheral neuropathy; faster titration than gabapentin
• Duloxetine (Cymbalta) — FDA-approved for diabetic neuropathy; SNRi mechanism; effective for painful neuropathy, particularly burning pain; also treats comorbid depression/anxiety
• Tricyclic antidepressants (amitriptyline, nortriptyline) — effective for neuropathic pain at lower doses than antidepressant doses; anticholinergic side effects limit use in elderly patients

Topical Treatments

• Capsaicin cream (0.075%) — depletes substance P in peripheral nerve terminals; burning application sensation deters compliance; 8% capsaicin patch (Qutenza) requires office application but provides 3-month relief
• Lidocaine patches — provide focal pain relief for localized neuropathic pain areas
• Compounded neuropathy creams — combination topicals (ketamine/gabapentin/clonidine/lidocaine) are widely prescribed with variable evidence

Low-Level Laser Therapy (LLLT)

Low-level laser or photobiomodulation therapy uses specific wavelengths of near-infrared light to stimulate mitochondrial function and promote nerve fiber regeneration. Multiple randomized trials and meta-analyses show significant improvement in pain scores and nerve conduction velocity in diabetic peripheral neuropathy. At Balance Foot & Ankle, LLLT is offered as an adjunctive treatment for symptomatic neuropathy.

Physical Therapy and Exercise

Aerobic exercise (walking, cycling) improves intraepidermal nerve fiber density and reduces neuropathy symptoms in multiple controlled trials. Structured exercise programs 3 times per week produce measurable improvement in sensation and pain over 10–16 weeks.

Protective Foot Care

Perhaps the most clinically important intervention in practice — annual diabetic foot exams, proper footwear, and regular professional nail and callus care prevent the ulcers and infections that are the end result of untreated sensory neuropathy. Patients with significant neuropathy should see their podiatrist at minimum every 3–6 months regardless of active symptoms.

Peripheral Neuropathy Foot Treatment in Michigan

Numbness, tingling, or burning in your feet? Our podiatrists specialize in peripheral neuropathy management with comprehensive nerve assessments and protective foot care programs.

Learn About Our Neuropathy & Vascular Foot Care → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Callaghan BC, et al. Diabetic neuropathy: clinical manifestations and current treatments. The Lancet Neurology, 2012;11(6):521-534.
2. England JD, et al. Practice parameter: evaluation of distal symmetric polyneuropathy. Neurology, 2009;72(2):177-184.
3. Boulton AJ, et al. Comprehensive foot examination and risk assessment. Diabetes Care, 2008;31(8):1679-1685.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

Board-Certified · FACFAS

Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

Dr. Tom Biernacki, DPM

Affiliate Disclosure: This page contains affiliate links to products we recommend. If you purchase through these links, Balance Foot & Ankle may earn a small commission at no additional cost to you. We only recommend products we use with our patients.

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.