Exercise guide
Peripheral neuropathy is damage to the nerves in your feet, legs or hands, most often from diabetes. It can make your feet numb, tingling or painful and your balance less steady. Exercise can't bring back lost feeling, but balance and strength training improve balance and walking, and walking in good shoes is safe for most people with numb feet.
Because you may not feel a blister or a cut, check both feet every day and after exercise, wear well-fitting shoes for anything you do on your feet, and hold a counter for balance work. With an open sore, an ulcer, or a red, hot or swollen foot, stop weight-bearing exercise and see your foot team within 24 hours.
This guide covers what the trials show, walking with numb feet, foot checks and footwear, balance and falls, nerve pain, and the warning signs. It ends with a 35-minute routine you can follow with 3D demos.
Across 16 trials, exercise improved balance scores and made people quicker on a standard get-up-and-walk test, though the evidence is low certainty. It hasn't been shown to bring back lost feeling: badly damaged nerves usually can't repair themselves.
In a trial of 79 people with diabetic neuropathy, a walking and leg exercise programme didn't significantly increase foot ulcers. The American Diabetes Association (ADA) says moderate walking in proper footwear may not raise ulcer risk, and the international foot guideline says an extra 1,000 steps a day is likely safe.
Look before your socks go on and at bedtime, using a mirror or a helper, and again after every walk. Check inside your shoes before you put them on, and never walk barefoot, even at home.
An open sore, an ulcer, or a red, hot or swollen foot needs your foot team within 24 hours, and only seated or other non-weight-bearing exercise until they say otherwise. A hot, swollen foot can be Charcot foot, even if it doesn't hurt.
The ADA advises balance training 2 to 3 times a week for adults with diabetes aged 50 and over, particularly with neuropathy. Whether it prevents falls in neuropathy itself is unproven: the falls evidence comes from older people in general, where exercise cuts falls by about a quarter.
Diabetes control, cutting down on alcohol and treating low vitamin B12 matter more than any exercise, and nerve pain is treated mainly with medicines such as amitriptyline, duloxetine, gabapentin or pregabalin.
Damage to the nerves outside the brain and spinal cord, mainly in the hands, feet and arms. The commonest kind affects the longest nerves first, so it starts in the feet and later reaches the hands. Symptoms include numbness, tingling, burning or shooting pain, weakness, and loss of balance and co-ordination.
Burning or tingling in one foot only, centred on the inner ankle and sole, can be a nerve trapped at the ankle instead (tarsal tunnel syndrome), which has its own pain guide. Either way, see a GP to get it checked.
Almost 1 in 10 people aged 55 or over in the UK have it. Diabetes is the commonest cause; others include long-term heavy drinking, low vitamin B12, an underactive thyroid, chemotherapy and some other medicines, kidney or liver disease, some infections, including HIV, and some inherited and immune conditions. Sometimes no cause is found.
With less feeling in your feet, it's harder to tell where they are, which affects balance and co-ordination, and the ADA lists falls among the effects. Balance also relies on your eyes and inner ears, so with numb feet, poor light makes balance harder (our explanation).
If your feet are numb, it's easy to cut them on something sharp or get a blister from a badly fitting shoe without noticing, and a small wound can turn into an ulcer. Up to half of diabetic neuropathy causes no symptoms at all, which is why foot checks matter.
With neuropathy, the bones and joints of the foot can be damaged without pain. A red, warm, swollen foot, with or without a change in shape, needs a foot team quickly, even if it doesn't hurt.
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When neuropathy affects the nerves that control your heart and blood pressure, you may get dizzy or faint when you stand up and be unable to exercise for more than a short time.
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Everyone with diabetes should have a foot check at least once a year and be told their risk. Neuropathy alone counts as moderate risk, and neuropathy with poor circulation, callus or a change in foot shape, or a past ulcer or amputation, as high risk; both mean a referral to a foot protection service.
In 16 trials (759 middle-aged and older people with diabetic neuropathy), exercise improved the Berg balance score by about 2 points out of 56 and made the timed up-and-go test about 1.7 seconds faster, but didn't improve how far people walked in 6 minutes. The certainty was low to very low, and a second review found similar gains from studies of low quality.
A review of 41 trials concluded that combining endurance training with balance training works best for diabetic neuropathy. Another, of 21 trials in older adults, found balance and mixed programmes improved fall-risk tests most and strength training less, while foot and ankle exercises on their own didn't improve the timed up-and-go or walking speed.
In 71 people with type 2 diabetes, most with mild neuropathy, 12 weeks of twice-weekly gait and balance training with strength work, led by physiotherapists, made walking faster and improved balance and confidence, and most of the gains lasted 6 months. Two people had Achilles pain.
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In a supervised trial of 29 people, standing and walking exercise added 29 metres to a 6-minute walk and about 1,178 steps a day more than seated exercise did, while the seated group's blood sugar improved more. There were 4 foot ulcers in 3 people, 3 of them among the 5 people who'd had an ulcer before.
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In the Feet First trial (79 people, 12 months), a walking and leg exercise programme didn't significantly increase foot ulcers. Guidelines now say walking in proper footwear may not raise ulcer risk, and that an extra 1,000 steps a day is likely safe.
In 3,617 older adults, those with neuropathy were 48% more likely to have a fall or fracture. Only one small trial has measured falls in diabetic neuropathy, with no clear effect, so falls prevention in neuropathy itself is unproven. The falls evidence comes from older people in general, where exercise cuts falls by about a quarter.
In two small studies without a comparison group, supervised exercise made pain interfere less with walking and sleep (14 people), and reduced pain and symptoms (17 people). A review of 11 trials (517 people) found short-term improvements in symptoms, with very low certainty, and the ADA finds no compelling evidence that lifestyle changes treat nerve pain.
In 78 people with diabetes but no neuropathy, 4 years of supervised brisk walking was followed by less nerve damage (in the sensory nerves, 6.5% against 29.8%), in a small trial with unequal groups. The ADA says regular aerobic exercise may prevent or delay neuropathy.
In a review of 12 studies (928 people), exercise improved symptoms, balance and quality of life, and another review found balance training the most important part. No medicine prevents neuropathy from chemotherapy, and duloxetine is the only one with evidence for its pain, with limited benefit.
In 18 inactive people with neuropathy, supervised moderate aerobic exercise caused 57 minor problems, none serious, and improved tiredness and fitness. Start gently and build up.
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Aim for 150 minutes of moderate activity a week (the NHS and the ADA), strength work 2 to 3 times a week, and balance work 2 to 3 times a week if you're 50 or over. Wear proper footwear and check your feet daily, avoid weight-bearing with a foot injury or open sore, limit long hikes, jogging and uneven ground, and avoid activities that need a lot of balance.
Weight-bearing exercise used to be discouraged with diabetic neuropathy. After the Feet First trial, its authors concluded that walking can be considered after a proper assessment and advice.
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In the weight-bearing trial, daily steps went up by about 10% every 2 weeks. Our editorial starting point: add about 10% to your usual daily steps every 2 weeks, up to about 1,000 extra steps a day as a first target.
Walk on even ground in well-fitting shoes and socks that don't rub, limit long hikes, jogging and rough ground, and check your feet after every walk.
Cycling, chair exercise and swimming may suit you better if your feet or your walking have changed, but don't swim or do water exercise with an unhealed ulcer on the sole of your foot.
A past ulcer is an important warning sign: in the weight-bearing trial, most of the ulcers were in people who'd had one before. If you've had an ulcer, an amputation or Charcot foot, or your foot team says you're high risk, plan exercise with them, and favour seated or water exercise once any wound has healed (our suggestion).
Check your feet morning and night and after exercise. Do the routine at the end of this guide 3 times a week, on days that aren't back to back, and on 2 or 3 other days do 20 to 30 minutes of cycling, swimming (if your skin is intact) or walking on even ground.
Look at both feet before your socks go on in the morning and at bedtime, including the soles and between the toes, with a mirror or a helper. Feel for patches that are hotter or colder than usual.
Check inside your shoes for anything sharp before you put them on, and check your feet again after every walk or session: it's the best way to spot blisters or cuts early.
Choose wide-fitting shoes with a deep, rounded toe area, a flat or low heel and laces or a buckle, and wear new shoes indoors for 20 to 30 minutes at a time at first. Wear socks that keep your feet dry. Don't walk barefoot or in open-toed shoes, even at home.
Wash your feet every day without soaking them, test the water with your wrist or elbow, moisturise but not between the toes, cut your nails carefully, and don't use blades or corn plasters. See a podiatrist for corns, hard skin or ingrown nails.
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With a helper, the Touch the Toes test checks the feeling in 6 toes. If you feel 4 or fewer of the touches, your feeling is reduced: book a foot examination with your GP. Everyone with diabetes should still have a yearly foot check.
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Sit or lie down, take the weight off the foot and keep it raised, and contact your GP or foot protection team straight away. The warning signs below list what needs seeing within 24 hours.
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In 3,617 older adults (average age 79), a third had neuropathy on a simple foot test, and over 3 years 26.5% of them had a recorded fall or fracture, against 18.4% of those without it. Reviews find diabetic neuropathy affects balance and walking and raises the risk of falls.
Balance training improves balance tests in neuropathy, and the ADA says it can reduce the risk of falls even when neuropathy is present. Whether it prevents falls in neuropathy itself is unproven, from one small trial; the falls evidence comes from older people in general, where balance and functional exercise cuts falls by about a quarter.
Balance work 2 to 3 times a week, next to a counter, in shoes. In the weight-bearing trial, one-leg stands were held for 30 seconds, twice, moving from both hands on a support to one hand to none.
Hold a counter or the back of a sturdy chair for every standing balance move, keep your shoes on, clear the floor, put the light on at night, and keep a phone or alarm with you. Avoid activities that need a lot of balance, such as a wobble board with nothing to hold. Falls guidelines also ask clinicians to check for unsuitable footwear, including going barefoot.
If you've fallen or are worried about falling, see your GP, who can check your balance and medicines and refer you to a falls service; in some areas you can refer yourself. The falls assessment from the National Institute for Health and Care Excellence (NICE) covers balance, strength, medicines and your feet.
2 to 3 times a week, in shoes. In the weight-bearing trial, one-leg stands were held for 30 seconds, twice, from both hands on the counter to one to none, and side and backward steps were 10 steps, twice, with one hand on the counter. Leave the balance board out if your feet are very numb.
3D demoSingle-leg standBeginner · A wall
3D demoSemi-tandem stanceBeginner · A wall
3D demoTandem stance and heel-to-toe walkBeginner · A wall
3D demoSide-stepping (sideways walking)Beginner · A wall
3D demoBackward walkingBeginner · No equipment
3D demoBalance board standBeginner · Other / check instructions2 to 3 times a week. The trial built sit-to-stands from 2 sets of 3 to 2 sets of 15, and calf raises and heel stands (toes up, back to a wall) from 2 sets of 5 to 2 sets of 20. Skip calf raises if you have hard skin, a sore or a past ulcer under the ball of your foot.
3D demoSit to stand from a chairBeginner · A bench or box
3D demoSlow calf raiseBeginner · A wall
3D demoTibialis raiseBeginner · No equipment
3D demoLow step-upBeginner · A step
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoWall push-upBeginner · A wall
3D demoBand rowBeginner · A band + An anchor pointGood for your feet, and the international foot guideline suggests foot and ankle exercises for people at low to moderate risk of ulcers, but on their own they don't train balance. Do the towel curl sitting down, and check your skin afterwards.
Build towards 150 minutes a week (NHS). Add about 10% to your daily steps every 2 weeks, walk on even ground, and use the bike or rowing machine on days your feet need a rest.
Hold calf stretches for about 30 seconds (our suggestion). No trial has tested hand exercises in neuropathy, but keeping your fingers and wrists moving is a reasonable way to look after stiffness and grip (our suggestion).
3D demoWall calf stretch (gastrocnemius)Beginner · A wall
3D demoSoleus wall stretchBeginner · A wall
3D demoSeated calf stretch with a towelBeginner · Other / check instructions
3D demoTendon glides (hand tendon gliding exercises)Beginner · No equipment
3D demoBall squeezeBeginner · Other / check instructions
3D demoWrist & forearm flowBeginner · No equipmentBetter diabetes control may improve neuropathy or stop it getting worse; stopping smoking and cutting down on alcohol help; and low vitamin B12 is treated with injections or tablets.
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Nerve pain usually doesn't respond to everyday painkillers. NICE recommends offering a choice of amitriptyline, duloxetine, gabapentin or pregabalin first, and capsaicin cream for pain in one area. Never stop or change a medicine yourself.
Small studies suggest exercise may make nerve pain easier to live with, but medicines are the main treatment for the pain itself. Treating sleep and mood problems matters too.
Stand up slowly, drink plenty of fluids and wear compression stockings if they've been advised. Judge effort by how hard it feels rather than by heart rate, avoid exercising in the heat, and have a heart check before exercise that's harder than you're used to.
Exercise, especially balance work, can help. A bike or swimming may suit you better than brisk walking on rough ground; our cancer guide covers exercise during and after treatment.
Do the neuropathy routine 3 times a week. Wear shoes for anything standing in these workouts, including the foot and ankle routine, and check your feet afterwards; use the chair workout on days with a sore foot.
A 35-minute home routine for numb feet: seated ankle work, leg strength and balance at a counter, then a walk, with shoes on and a foot check before and after.
35 minBeginner13 movesA bench or box, Something with weightA 40-minute strength and balance session for over-65s, built from the Otago home programme and NHS exercises, using a chair, a counter and a step.
40 minBeginner18 movesA bench or box, Something with weightBalance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxA 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.
20 minBeginner11 movesA bench or box, Something with weightA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallStrength and balance in one session: squats, Romanian deadlifts, push-ups, rows, step-ups, back extensions, carries and single-leg balance.
45 minBeginner14 movesA wall, A dumbbellA 15-minute barefoot routine for stronger toes, arches, calves and ankles, finishing with balance. You need only a towel, a wall and a resistance band.
15 minBeginner11 movesA wall, Other / check instructionsStrength and balance 3 times a week plus walks; keep shoes on and check your feet after each session.
Take the weight off the foot, keep it raised, and contact your GP or foot protection team straight away, or an out-of-hours service if they're closed, if you notice:
The Diabetes UK helpline is 0345 123 2399, Monday to Friday, 9am to 6pm.
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In a trial of 79 people with diabetic neuropathy, walking and leg exercises didn't significantly increase ulcers, and guidelines say walking in proper footwear may not raise ulcer risk. The rules: good shoes, daily foot checks, and no weight-bearing with an open sore.
Exercise improves balance and walking, and one small trial suggests it may delay neuropathy starting, but no trial shows lost feeling coming back. Badly damaged nerves usually can't repair themselves.
Numb feet don't warn you: a blister or cut can go unnoticed and turn into an ulcer, and up to half of diabetic neuropathy causes no symptoms. Look rather than wait to feel something: check every day.
With neuropathy, don't walk without suitable foot protection, including at home. Falls guidelines also ask clinicians to check for unsuitable footwear, including going barefoot.
Balance training improved balance tests across 16 trials, and the ADA advises balance work 2 to 3 times a week for adults with diabetes aged 50 and over, particularly with neuropathy.
Rest doesn't treat nerve pain. Medicines are the main treatment, and in small studies exercise made pain interfere less with walking and sleep.
Toe and ankle exercises are worth doing for your feet, but in a review of 21 trials, foot and ankle exercises on their own didn't improve the timed up-and-go or walking speed, while balance and mixed programmes did.
They're good when your feet need a rest, but they don't train standing balance, which the ADA advises as well. And don't swim with an unhealed ulcer on the sole of your foot.
A mix: balance exercises next to a counter, strength work for your legs and ankles, and walking or cycling. Combining endurance and balance training has the best support in trials. The American Diabetes Association advises 150 minutes of aerobic activity a week and strength work 2 to 3 times a week, plus balance work 2 to 3 times a week for adults aged 50 and over, particularly with neuropathy.
Yes, for balance, strength and walking: across 16 trials, exercise improved balance scores and made people quicker on a standard get-up-and-walk test, though the certainty is low. Effects on numbness and pain are small and uncertain, so treating the cause, such as blood sugar, alcohol or low vitamin B12, still matters most.
It hasn't been shown to bring back lost feeling. One small 4-year trial found brisk walking delayed neuropathy developing in people with diabetes, but once nerves are badly damaged they usually can't repair themselves. Some neuropathy improves when its cause is treated.
Yes, in well-fitting shoes. A trial of walking and leg exercises didn't significantly increase foot ulcers in people with diabetic neuropathy, and the international foot guideline says an extra 1,000 steps a day is likely safe. Walk on even ground, limit long hikes and jogging, and check your feet afterwards.
Limit long hikes, jogging and walking on uneven ground, and avoid activities that need a lot of balance, such as a wobble board with nothing to hold. With a foot injury or an open sore, avoid weight-bearing exercise, and don't swim with an unhealed ulcer on the sole of your foot. Always do balance practice next to something you can hold.
Practise 2 to 3 times a week next to a counter, in shoes: narrow and heel-to-toe stands, one-leg stands, side-stepping and walking backwards, using less hand support as you improve. Add sit-to-stands and calf and shin raises for ankle strength. If you're unsteady, our balance test page has a 4-stage version; with numb feet, do it in shoes with someone beside you.
Yes. Check every day, before your socks go on in the morning and at bedtime, with a mirror or a helper, and again after every walk or session. Check inside your shoes for anything sharp before you put them on.
Don't walk or stand barefoot: the international foot guideline advises against walking without suitable foot protection, and the American Diabetes Association advises against going barefoot at home. Seated toe and ankle exercises in socks are fine if you check your skin afterwards (our suggestion).
In small studies, exercise reduced how much pain got in the way of walking and sleep, though not always the pain itself. Medicines such as amitriptyline, duloxetine, gabapentin or pregabalin are the main treatment for nerve pain; talk to your GP rather than changing anything yourself.
Trials suggest it does, especially balance training, which seems the most important part. A bike or swimming may suit you better than brisk walking on rough ground, and our cancer guide covers exercise during and after treatment.
Neuropathy makes it harder to tell where your feet are, which affects balance and co-ordination, and your eyes and inner ears have to work harder. In one large study, older adults with neuropathy were about 50% more likely to have a fall or fracture, so balance training, good shoes, good light and something to hold all help.
Within 24 hours for a red, hot or swollen foot, a new blister or cut, a smelly or leaking wound, or new foot pain; take the weight off it meanwhile. See your GP for new tingling, numbness, weakness or poor balance, and have your feet checked every year if you have diabetes.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
