What Tests Should Be Done for Neuropathy? A Simple Patient Checklist

johnhayesjr1
6 days ago
4 min read

If you’ve been told you have “neuropathy” (or you suspect it), it’s easy to feel stuck—especially if the only plan offered is, “Here’s a medication. Let me know if it helps.” The problem is that neuropathy is not one diagnosis with one cause. It’s a description of nerve dysfunction, and there are many reasons it can happen.

A good evaluation is about answering two key questions:

What type of neuropathy is this (and how severe is it)?
What’s driving it—and what can we do about it?

Below is a patient-friendly checklist you can use to make sure nothing important is missed.

Step 1: A Focused History (This Is a “Test,” Too)

Before labs or imaging, a clinician should ask questions that point toward likely causes.

Expect questions like:

When did symptoms start—suddenly or gradually?
Are symptoms in both feet? One foot? Hands too?
Is it numbness, burning, tingling, “zaps,” or balance issues?
What time of day is worst (night, after meals, after sitting)?
Any diabetes, prediabetes, thyroid problems, autoimmune conditions?
Alcohol use (even moderate can matter for some people)
Prior chemotherapy or certain medications?
Occupational exposures (solvents, heavy metals)?
Family history of neuropathy?

Why it matters: The symptom pattern often points toward specific causes and helps prioritize the right tests.

Step 2: A Proper Neurologic + Foot Exam

A thorough exam should include both nerve and safety checks.

Common exam components:

Sensation testing (light touch, pinprick, vibration)
Reflexes (ankle reflexes can be reduced with neuropathy)
Strength testing (especially ankles/toes)
Balance and gait (how you walk, turn, and stand)
Foot inspection (skin changes, calluses, sores, temperature differences)

Why it matters: Neuropathy isn’t just discomfort—it can affect balance and increase injury risk without you noticing.

Step 3: Circulation Screening (Don’t Skip This)

Not all neuropathy is caused by poor circulation, but circulation problems can mimic or worsen symptoms—and they must be identified.

Ask about:

Pulse check in the feet
Capillary refill (how fast color returns to toes)
Skin temperature/color changes
If concerns exist: ABI test (ankle-brachial index) or vascular referral

Why it matters: If blood flow is limited, some treatments and even compression strategies may be inappropriate without clearance.

Step 4: The Most Common Lab Tests to Consider

These labs help identify the “fixable” contributors. Not everyone needs every test, but these are often considered in a comprehensive workup.

Blood sugar and metabolism

Fasting glucose
Hemoglobin A1c
Sometimes fasting insulin or a glucose tolerance test (case-by-case)

Why: Diabetes and prediabetes are among the most common neuropathy drivers.

Vitamin and nutrient status

Vitamin B12 (and sometimes methylmalonic acid if borderline)
Vitamin D
Folate (case-by-case)

Why: Deficiencies can worsen nerve function and are often treatable.

Thyroid function

TSH (and sometimes free T4)

Why: Thyroid disorders can contribute to nerve symptoms.

Inflammation and autoimmune screening (when indicated)

ESR/CRP
Additional autoimmune markers based on symptoms/history (case-by-case)

Why: Some neuropathies are immune-mediated and require a different approach.

General health screening

CBC (blood count)
CMP (kidney/liver function, electrolytes)

Why: Kidney disease, liver issues, and metabolic imbalances can affect nerves.

Other tests sometimes considered (depending on your story)

Serum protein electrophoresis (SPEP) / immunofixation (certain patterns)
Iron studies
Magnesium
Infectious causes (Lyme, hepatitis, HIV) based on risk factors

Bottom line: Your history and exam should guide which of these make sense.

Step 5: When Nerve Testing Is Helpful

If the diagnosis is unclear, symptoms are progressing, or there’s weakness, additional testing may be recommended.

EMG/NCS (Electromyography / Nerve Conduction Studies)

What it does: Measures nerve signal speed and muscle response.Helpful for: Confirming neuropathy type, severity, and whether it’s coming from nerves vs. nerve roots (like the spine).

Small Fiber Neuropathy Testing (Case-by-Case)

Some people have classic burning pain but “normal” EMG/NCS results. That can happen with small fiber neuropathy.

Possible evaluation options:

Skin biopsy (specialized testing)
Autonomic testing (if you have sweating/blood pressure/HR symptoms)

Step 6: When Imaging Might Be Needed

If symptoms are one-sided, tied to posture, include back pain, or involve weakness, your clinician may consider imaging.

Common examples:

Lumbar spine imaging if there’s suspicion of nerve root compression
Foot/ankle evaluation if entrapment is suspected (like tarsal tunnel)

Imaging isn’t routine for every neuropathy case—but it’s important when the pattern suggests mechanical involvement.

Step 7: Medication and Toxin Review (Often Overlooked)

This is a big one. A good neuropathy evaluation should include:

Review of current and past medications
Alcohol intake discussion
Occupational or environmental exposures

Some medications and toxins can irritate nerves or worsen symptoms, and identifying this can change the plan dramatically.

Bring This “Patient Checklist” to Your Appointment

Here are smart questions to ask:

What do you think is the most likely cause of my neuropathy?
Which labs are you ordering—and what are we looking for?
Are you checking circulation as part of this evaluation?
Do my symptoms suggest large fiber neuropathy, small fiber neuropathy, or a spine/entrapment issue?
What are the next steps if tests are normal but symptoms persist?
How will we measure progress over time?

Call to Action

If you’ve only been offered symptom management—or if you’re unsure whether your neuropathy has been fully evaluated—schedule a neuropathy consultation. A thorough workup can identify treatable contributors, protect function and balance, and create a clear plan so you’re not left guessing.