Peripheral Neuropathy
Loss of sensation, tingling or stiffness in the feet and toes is common in older adults, especially alongside diabetes or arthritis, and it raises the risk of falls and unnoticed injury.
Common symptoms
- , Numbness or reduced sensation in the feet or toes
- , Tingling, burning or a 'pins and needles' feeling
- , Stiffness or reduced movement in the toes
- , Unsteadiness or a feeling of walking on cotton wool
- , Wounds or sores on the feet that were not noticed early
Common causes
- , Diabetes, the most common cause seen in Nairobi
- , Long-standing arthritis affecting the small joints of the foot
- , Vitamin B12 deficiency
- , Nerve compression or age-related nerve changes
- , Certain medications
Why this often gets dismissed as “just old age”
Numbness, tingling or stiffness in the feet is genuinely common in older adults, which is exactly why it gets waved away as an inevitable part of ageing. It is not. It usually has an identifiable cause, most often diabetes or long-standing arthritis, and even where the nerve change itself cannot be reversed, the consequences of it (falls, unnoticed injury, reduced confidence walking) are very much treatable.
The fall risk this creates
Balance relies on three sources of information: the eyes, the inner ear, and sensation from the soles of the feet. When that third source is reduced, the other two have to do more work, and they do it less well in dim light or on uneven ground. This is a large part of why falls become more common as neuropathy progresses, and it is a risk we address directly rather than treating the numbness in isolation.
Why we teach the family, not just the patient
Someone who cannot fully feel their feet can develop a wound or sore without noticing, and in diabetes in particular, an unnoticed foot injury is one of the more serious complications that can follow. Part of what we do on a first visit is teach a simple daily foot check: what to look for, and what warrants urgent attention rather than waiting for a scheduled appointment.
Whoever sees the patient day to day, often a daughter, a niece, or another family member, is usually better placed to keep that habit going than the patient themselves, and we build the plan around that reality rather than around an ideal that assumes the patient will manage it alone.
What treatment actually involves
Balance retraining that accounts for reduced foot sensation, gentle mobilisation of stiffness that has developed in the toes and midfoot, gait work to reduce fall risk on the surfaces the patient actually walks on, and practical guidance on footwear that protects a foot which cannot always warn its owner when something is wrong.
How we treat it
- , Balance and falls-prevention training, since reduced foot sensation increases fall risk directly
- , Gentle mobilisation of stiff toe and foot joints
- , Sensory re-education exercises
- , Gait retraining and appropriate footwear advice
- , A daily foot-check routine, taught to the patient and to whoever supports them
Typical recovery: Sensation lost to nerve damage does not always fully return; the realistic goal is safer walking and fewer falls, alongside management of the underlying cause
See a doctor urgently if you have
- !A foot wound, sore or ulcer, especially in someone with diabetes
- !Sudden numbness or weakness affecting one side of the body
- !Rapidly worsening numbness over days
- !Signs of infection in the foot: redness, warmth, swelling or discharge
These are not physiotherapy problems. Go to a doctor or hospital rather than booking with us.
Treatments that help
Common questions
My uncle has lost feeling in his feet and his toes have become stiff. Can physiotherapy actually help, or is this just old age?
It is common, but it is not something to leave unaddressed. We cannot always restore lost sensation, particularly where nerve damage is established, but we can improve his balance and walking safety, mobilise the stiff toe joints, and, most importantly, teach him and his family how to check for problems he can no longer feel forming.
Why does numbness in the feet matter so much for falls?
Balance depends heavily on feedback from the soles of the feet. When that feedback is reduced, the brain gets less information about the ground, and the risk of a stumble or fall rises sharply, particularly on uneven surfaces or in poor light.
He doesn't want to see a doctor about it. Should we wait?
We would still encourage a medical review, because neuropathy usually has an underlying cause (diabetes being the most common) that is worth identifying and managing properly. In the meantime, we can start on the balance, stiffness and foot-safety side of things, which does not need to wait for that appointment.
Can you check his feet if he cannot see or feel them well himself?
Yes. A daily foot check is one of the simplest, most effective things we teach families to do, precisely because a small wound that would normally hurt and get attention can otherwise go unnoticed until it becomes serious.
Book a physiotherapist in Nairobi
Clinic appointments in Westlands, or a physiotherapist at your door anywhere in Nairobi. Same-week slots.