The earliest signs of nerve damage are usually sensory: tingling, numbness, burning or pins and needles, typically starting in the toes or fingertips and spreading slowly upward. Weakness, clumsiness and muscle wasting tend to appear later. Reduced sensation is easy to miss because it is an absence rather than a symptom, and is sometimes first noticed as not feeling a small injury.
The earliest signs of nerve damage are usually sensory: tingling, numbness, burning or pins and needles, typically starting in the toes or fingertips and spreading slowly upward. Weakness, clumsiness and muscle wasting tend to appear later. Reduced sensation is easy to miss because it is an absence rather than a symptom, and is sometimes first noticed as not feeling a small injury.
Peripheral nerve damage typically begins at the longest nerves, which is why symptoms usually start in the feet and only later involve the hands. The early sensations include tingling, numbness, a burning quality, an intermittent electric feeling, or the sense of wearing socks or gloves that are not there. Many people describe it as worse at night. Reduced sensation is easy to miss because it is an absence rather than a symptom, and it is sometimes first noticed as difficulty telling hot from cold or not feeling a small injury.
As the process continues, motor signs can appear: mild weakness, tripping over uneven ground, difficulty with fine tasks such as buttons or keys, and in time visible thinning of muscles in the hands or feet. Balance often worsens in the dark, because vision has been compensating for lost sensation. Reduced sensation in the feet also raises the risk of unnoticed injury, which is why foot inspection becomes important in anyone with diabetes and sensory symptoms.
Some causes are reversible or controllable: vitamin B12 deficiency, thyroid disease, blood glucose control, alcohol, and certain medications. Addressing those can halt or improve the process, whereas established nerve damage recovers slowly if at all. Compression at a single site, such as the wrist, is the clearest example, since treatment before muscle wasting begins changes the achievable outcome. Electrodiagnostic testing localises the problem and is performed at both CNS offices.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.