Nutritionally induced peripheral neuropathies.
The authors have presented a discussion of some of the more common nutritional deficiency syndromes. A discussion of the etiology, clinical manifestation, diagnosis, and prognosis has been provided. Special attention has been given to the relationship between nutritional deficiency and the development of peripheral neuropathies. When patients suffering from peripheral neuropathy present, the possibility of a nutritional deficiency should be considered. The diagnosis of a nutritional deficiency neuropathy is rarely established. This may not merely be the result of a low incidence of the problem. The prompt diagnosis and treatment may afford dramatic results. The more protracted the course for diagnosis, the less favorable the prognosis. It is often difficult to pinpoint the exact nutritional deficiency present. Various methods have been discussed in this article; however, often multiple deficiencies are present simultaneously. The treatment with pharmacologic supplementation is usually very innocuous. It often proves beneficial to administer pharmacologic supplementation for a short period. This will aid in the differential diagnosis. Often prescribing a patient large doses of the B-complex vitamins for a limited time will allow the physician to determine if a nutritional neuropathy is present. It should also be remembered that just because a patient is suffering from a peripheral neuropathy from a metabolic disease or secondary to medication, they may also be suffering from a nutritional deficiency simultaneously. We believe that the podiatric physician is well trained to extend comprehensive treatment of pedal manifestations of peripheral neuropathies. Podiatric physicians have a large armamentarium at their disposal to treat the pedal manifestations of the disease sufficiently. These treatments may be conservative or surgical in nature, as previously discussed. We hope that this discussion will increase the awareness of the physician to the various ramifications of nutritionally induced neuropathies as well as the provision of insight into the most efficacious means available for appropriate management.