Loss of Feeling in Toe & Feet: What is the Cause and Treatment?

After an accident or illness, it is possible to gradually or suddenly lose feeling in one or both feet and toes.

This loss of sensation is sometimes accompanied by pain, numbness, unpleasant sensations, and can be very troublesome in daily life.

People who are affected often want to regain normal feeling as quickly as possible, even if they have other problems.

Are there things that can be done to regain better feeling in the foot or toe more quickly? What can be done in physiotherapy, occupational therapy, or simply at home?

What is loss of feeling in the foot or toe?

Some terminology is important at this stage, because sensory disorders are called by many different names. Here are some terms used:

• Paresthesia (abnormal but non-painful sensations such as tingling, numbness, drafts, a sensation of cardboard skin, or a feeling of heat or cold)
• Dysesthesia (abnormal and often painful sensations caused by contact or movement; they can be expressed as tingling, burning, or pain)
• Hypoesthesia (a decrease in sensitivity; the person may have a poor or no sensation of the ground when they put their foot down and may need to look where they put their foot to know when it touches the ground)
• Hyperesthesia (an excess of sensitivity).

All these terms can be classified under the broad category of sensory or feeling deficits or superficial or deep sensory loss.

Loss of feeling in the foot can affect the entire foot or only part of it, such as the big or little toe. Loss of feeling under the sole of the foot is also possible.

There are two main types of sensitivity:

• Superficial sensitivity. A person with a total sensory deficit will not feel when touched, even with significant pressure; there are three subtypes of superficial sensitivity: touch sensitivity, pain sensitivity, and temperature sensitivity.
• Deep sensitivity or proprioception. This is what allows us to perceive the position of our body in space. For example, in the case of total loss of deep sensitivity in the foot, a person who does not look at their foot will not know if it is raised upward or falling downward.

Both types of sensitivity can be affected at the same time, or only one of them. Patient interviewing combined with clinical tests can objectively determine the areas of sensory disorders, the degree of impairment (total or partial), and the type of sensitivity involved.

The Mac Gill pain questionary helps to better qualify and quantify the pain related to sensory disorders. It takes into account the patient’s subjective experience and helps to listen to the patient, which is already a first step in treating pain and sensory disorders.

What causes loss of feeling in toes or feet?

The loss of feeling in the foot or any other part of the body is related to a nervous system impairment. It can be:

• Central nervous system impairment (the brain and spinal cord); this is called central origin sensory impairment.
• Peripheral nervous system impairment (nerves outside of the brain and spinal cord that are present throughout the body); this is called peripheral origin sensory impairment.

Whether the impairment is peripheral or central, it can be total or partial, and permanent or temporary.

An accident or a genetic or acquired disease can cause dysfunction of the nervous system, resulting in sensory impairments.

The following are some examples of causes of loss of feeling in toes or feet:

For the central nervous system:

• Spinal cord injury resulting in paraplegia or tetraplegia, or paraparesis or tetraparesis
• Traumatic brain injury
• Stroke
• Cerebral palsy
• Dural breach (following spinal anesthesia, neurosurgery)
• Etc.

For the peripheral nervous system:

• Polyneuropathy
• Diabetic neuropathy (in people with diabetes)
• Injury resulting from trauma
• Nerve compression by a tumor
• Paralyzing sciatica or femoral neuralgia
• Etc.

What are the consequences of loss of feeling in toes or feet?

The consequences vary depending on the intensity of sensory disturbances. Generally, sensory disturbances have an impact on the daily lives of affected individuals: there are certain activities they can no longer do or have difficulty doing.

This can be, for example, walking on unstable terrain without technical assistance or foot lifters, or even walking indoors without holding onto the wall for some people.

Gait and balance are often affected. Once standing, postural sway is more significant because foot stability is less assured. Tactile and proprioceptive sensations provide essential information to the brain to balance the body. When these functions are altered, so are balance and gait.

Loss of foot feeling can lead to more frequent falls, slower and less enduring walking.

However, this is not inevitable, and some people can compensate for their sensory disturbances very well to continue to lead a normal life, engage in sports and work.

What can be done to regain feeling in the foot and toes?

Patients often seek treatment for their loss of feeling in the feet and toes, even if they do not necessarily limit their activities: the feeling itself, even if not painful, is unpleasant.

Several techniques and exercises are proposed by physiotherapists and occupational therapists to try to reduce sensory disturbances.

Few have been tested on a large number of patients and in a comparative way to determine whether it is the technique that improves sensory disturbances or simply the passage of time or general rehabilitation for other problems.

Sensory retraining has only been tested in clinical studies on people suffering from sensory disturbances following a stroke or facial injuries. What do these studies tell us?

After a stroke

After a stroke, sensory impairments are more significant in the legs than in the arms. Several studies have been conducted to evaluate the effectiveness of sensory rehabilitation after a stroke. In total, 430 people who suffered from lower limb sensory impairments after a stroke were included in these studies.

The activities performed by these individuals varied greatly depending on the studies in which they were included, including:

• Activities aimed at stimulating sensitivity to touch and movement in the hypoesthetic area, where individuals had to indicate if and where they were being touched, with what, etc.
• Treadmill walking, especially with eyes closed or blindfolded.
• Aquatic walking.
• TENS (Transcutaneous Electrical Nerve Stimulation is safe).
• Vibration stimulation.

These interventions occurred for a minimum of 30 minutes per day up to a maximum of 2 hours per day, 5 days a week, for 6 months.

After several months of rehabilitation, individuals generally improved their balance and sensitivity to touch or movement, but not their gait.

This was an improvement compared to their pre-treatment scores and compared to the scores of individuals who did not receive sensory-focused rehabilitation or who had less rehabilitation hours per week.

Based on the currently published studies, it is not possible to say that certain rehabilitation techniques work better than others to recover feeling in the foot, even those focused on sensitivity to touch.

There are also less specific studies that examine the impact of rehabilitation on sensory impairments after a stroke, whether they affect the upper or lower limbs. In total, the progress of 1,093 stroke patients with sensory impairments was evaluated.

The results of these studies suggest that passive sensory rehabilitation is more effective than active sensory rehabilitation for sensory and motor impairments.

Passive sensory rehabilitation refers to an external sensory stimulation approach with a purported priming mechanism of the nervous system. The sensory-deficit areas of patients are touched and stimulated with different textures, shapes, and temperatures, or even electrical currents (TENS), without requiring cognitive effort from the patient to recognize the areas and types of touch.

Active sensory rehabilitation is based on gradual rehabilitation using learning principles. Patients attempt to discriminate between different stimuli, recognize which texture touches them and where precisely, and try to distinguish between warmth and coldness, all in a progressive and conscious way.

Other recommendations for individuals with sensory impairments include staying as active as possible, maintaining a healthy lifestyle, protecting oneself from burns and accidents, and taking precautions to prevent sprains by wearing proper footwear, using walking aids if necessary, and using an ankle foot orthosis.

Move as much as possible

It is reasonable to think that the more active people with sensory impairments are, the more they will maximize their chances of recovery.

In addition, regular physical activity tends to decrease chronic pain by stimulating pleasant hormones and diverting attention away from pain.

Have a healthy lifestyle

Alcohol has a deleterious effect on both the peripheral and central nervous system in the short and long term.

Avoiding or limiting alcohol consumption can therefore be beneficial in maximizing the chances of a good sensory recovery.

Protect against burns and accidents

When experiencing feeling impairments, one can more easily get burned, for example, by not feeling that the shower water is too hot. In winter, frostbite is more likely to occur.

Therefore, one must be vigilant in situations with extreme temperatures.

The risk of ankle sprains is also more frequent in case of loss of foot sensitivity. One must ensure proper footwear, not hesitate to use a walking aid (hiking pole, walker, etc.), and consider using a brace or dynamic ankle foot orthosis.

What you can do with physiotherapist?

Physical therapists are trained in the rehabilitation of sensory disorders in the foot or any other part of the body. After conducting an interview and assessment, they will propose sessions tailored to the patient’s expectations and deficits.

Evidence-based physical therapists should primarily offer passive sensory rehabilitation techniques to patients with sensory disorders. In general, the sessions offered should aim to stimulate the patient’s tactile and proprioceptive senses as much as possible, encouraging cerebral plasticity.

There is no need for specific equipment to carry out this type of rehabilitation; everyday tools can be used.

Physical therapists also encourage self-rehabilitation by providing patients with exercises they can do outside of sessions. They also stress the importance of regular physical activity and a healthy lifestyle to maximize the chances of nerve regeneration and functional recovery.

What you can do with occupational therapist?

In rehabilitation centers or hospitals, patients with sensory disorders can benefit from occupational therapy sessions in addition to physical therapy sessions.

The rehabilitation methods are essentially the same, but the approach of occupational therapists and physical therapists may vary.

The main benefit of combining occupational therapy with physical therapy sessions is that rehabilitation time is increased.

Private occupational therapy is not reimbursed in France. Therefore, rehabilitation of sensory disorders is mainly carried out by physical therapists in private practice.

Wear compression socks

Wearing socks or compression stockings improves blood circulation in the lower limbs. This can theoretically relieve pain related to venous stasis, which can be exacerbated by sensory disorders.

In France: Socks and compression stockings can be covered by social security and mutual insurance companies if prescribed by a healthcare professional. Physical therapists can issue prescriptions for this reason.

How long does it take for sensation to return to the foot and toe?

How long does it take for sensitivity to return to the foot? It depends on several factors:

• Is it a central or peripheral nervous system disorder?
• Is the disorder total or partial?
• How long has the sensory deficit in the foot been present?
• Does the person with sensory disorder have a healthy lifestyle?

There is generally a greater chance of rapid and complete recovery when the sensory disorder is peripheral and partial. It is difficult to make an accurate prognosis of the timing and degree of sensory recovery in the foot when it first appears.

At best, one can speak of a delay of several months, in cases where sensitivity would return.

This is how things work and how fast they happen in the case of a peripheral disorder. When a nerve is severed, all the axons that go from the spinal column to the extremities of the hands and feet degenerate. Sensory impulses no longer transmit.

In some cases, however, the axon can regenerate. This is called nerve regeneration, or nerve regrowth.

It occurs at a very slow rate, about 1.5 mm per day. If a nerve is severed at the knee, it will take about a year for complete nerve regeneration to the foot to be expected. The delay may be longer if the section is higher.

An electromyogram can be done to determine if there is a chance that nerve regeneration will occur.