Grading of paresthesia:
Grade 1: Mild symptoms
Grade 2: Moderate symptoms
Grade 3: Severe symptoms; limiting self-care ADLs
Characterize the symptom (onset, pace)
Ask the patient:
Have you had issues with numbness/tingling in the past? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly?
Grade the symptom
Ask the patient:
How bad is the numbness/tingling? Is it affecting your ability to walk? Do you stumble? Do you need to look down and watch your feet when you walk?
Ask the patient:
Do you have any difficulty breathing? Have you fallen?
Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?
Patients with new onset moderate or worse (or worsening) symptoms should be seen.
Patients with any of the red-flag symptoms should be seen immediately.
What do you suspect is the cause of tingling feet?