“How’s the neuropathy?” is a hard question to answer well.
Most people say ‘about the same,’ which is usually a guess. Symptoms of Neuropathy fluctuate, while memory smooths things out. The things that matter most — balance, foot safety, function — aren’t what you notice day to day.
So here’s a structured self-audit across five domains related to Neuropathy. Score each one, add them up, and you’ll have a clearer view for tracking progress and sharing with a clinician.
One important clarification: this is not a validated diagnostic tool and it doesn’t diagnose anything. It’s an organized way of describing your situation. Take it to an appointment; don’t use it instead of one.
Domain 1: Sensation
Score the statement that best describes your experience with Neuropathy.
0 — I have no numbness or altered sensation. 1 — Occasional tingling or numbness that comes and goes. 2 — Constant altered sensation in my toes or fingertips. 3 — Numbness extending past my toes into my feet, or past my fingertips into my hands. 4 — Numbness extending up my legs toward my calves, or into my hands and wrists.
Why it’s scored this way: length-dependent neuropathies progress from the extremities inward, so how far it reaches matters more than how intense it feels. Movement up this scale over months is meaningful information.
Domain 2: Pain
0 — No pain. 1 — Occasional burning or shooting, not interfering with anything. 2 — Daily pain that I notice but work around. 3 — Pain that regularly disturbs my sleep. 4 — Pain that limits what I do most days, or that makes light touch uncomfortable.
A note on that last one: pain from something that shouldn’t hurt — bedsheets, socks, a light touch — has a specific name in clinical use and is worth reporting explicitly rather than describing as “it’s very sensitive.”
And separately: numbness and pain can coexist in the same area. That’s confusing and it’s common. Both belong in your description.
Domain 3: Balance and Falls
0 — Steady, including in the dark. 1 — Slightly less confident than I used to be, no near-falls. 2 — Noticeably worse in the dark or on uneven ground. 3 — Near-falls or stumbles in the last three months. 4 — One or more actual falls in the last year, or I’ve started avoiding activities because of unsteadiness.
Why this domain matters most: reduced sensation degrades the information your balance system relies on, and motor, sensory, and autonomic nerve damage can all raise fall risk. There’s also a secondary effect worth naming — a greater fear of falling, which can slowly reduce participation in activities and even going out at all.
If you scored 3 or 4 here, this is the domain to act on first, regardless of your other scores. Weekly balance training has been shown to reduce fall risk in people with diabetic peripheral neuropathy, and a supervised twelve-week program has produced improvements in gait speed, balance, strength, joint mobility, and fear of falling.
Note the word “supervised.” Home programs done unsupervised have shown weaker results, partly due to poor adherence.
Domain 4: Function and Strength
0 — No difficulty with anything. 1 — Occasional clumsiness — dropping things, fumbling buttons. 2 — Regular difficulty with fine tasks: buttons, jars, keys, utensils. 3 — Difficulty with stairs, rising from a chair, or walking distances I used to manage. 4 — I’ve given up specific activities because of it.
Why strength is in here: neuropathy affects motor nerves as well as sensory ones, producing weakness, incoordination, cramping, and muscle wasting. Weakness is also the compensation for lost sensation — the stronger you are, the more you can do without the feedback you’re missing.
Domain 5: Foot Risk
This one is scored differently, because it’s about injury risk rather than symptoms. Score 1 point for each that applies:
I can’t reliably feel pressure on the soles of my feet. I can’t reliably tell hot from cold on my feet. I don’t check my feet daily. I sometimes walk barefoot indoors or outdoors. I’ve had a blister, cut, or sore on my foot in the past year. I have diabetes, circulation problems, or a history of foot ulcer.
Any score of 2 or more here is worth acting on immediately, independent of everything else on this page. A foot that can’t feel can’t warn you — and loss of sensation means injuries go unnoticed until they’re advanced.
Adding It Up
Total domains 1 to 4 (maximum 16), and keep domain 5 separate.
0 to 4: Early or mild. This is the best window for intervention, and the one most commonly ignored because things still feel manageable.
5 to 9: Moderate impact. Function and balance are likely being affected in ways you may have adapted around without noticing.
10 to 16: Significant impact. Worth a comprehensive assessment covering balance, strength, gait, and safety, alongside making sure the medical side has been thoroughly investigated.
Domain 5 of 2 or more: Foot protection is your priority regardless of the other numbers.
What to Do With Your Score
Write it down with the date. Repeat in three months. The trend is more informative than any single result — and it’s the thing you genuinely can’t reconstruct from memory.
Take it to your appointments. “Balance scored 3, and it was 1 in the spring” is far more useful to a clinician than “about the same.”
Note which domain scored highest. That’s where to focus, and it’s frequently not the one producing the most noticeable symptoms. People commonly have pain at 2 and balance at 4, and spend all their attention on the pain.
The Domains That Need Different Doors
Domains 1 and 2 — sensation and pain — are largely medical territory. If the cause hasn’t been investigated, that’s a physician conversation. Blood tests can identify treatable contributors, and neuropathic pain has specific treatments that differ from ordinary painkillers.
Domains 3, 4, and 5 — balance, function, and foot risk — are largely rehabilitation territory. These respond to training regardless of whether the underlying nerve damage changes, which is the most important thing to understand about living with this.
That distinction matters because people often conclude that if the numbness isn’t improving, nothing can. In practice most of what limits daily life sits in the second group.
When to Seek Care Promptly
Prompt medical assessment for symptoms progressing or spreading rapidly; weakness that’s worsening; symptoms that began suddenly; any new wound, blister, or ulcer on a foot with reduced sensation; signs of infection; or any fall.
Emergency care for sudden numbness on one side of the body, particularly with facial droop, arm weakness, or difficulty speaking.
Bring Your Numbers In
A score gives a conversation something to work with. An assessment turns it into a plan.
McKenzie Physical Therapy offers a free discovery visit at no cost and no obligation. Bring your audit. You’ll get a thorough assessment of your balance, strength, gait, and fall risk, and a practical program targeting the domains that are actually costing you the most.
We work alongside your physician, not instead of them.