Exercises to Improve Balance with Neuropathy

by Dr. Emily Splichal, DPM MS

Feeling pain, tingling, numbness, or weakness in your hands or feet may be a sign of peripheral neuropathy.  With over 20 million Americans diagnosed with peripheral neuropathy, this is a common condition which contributes to impaired mobility, altered balance and increased fall risk.

The goal of managing peripheral neuropathy should be to maintain and restore the function of your peripheral nervous system, as well as optimize movement and balance to ensure a sufficient level of function.  

This article will go into a few of the most effective exercises and techniques for improving foot awareness and balance in those with peripheral neuropathy.  All of these recommendations can be performed on a daily basis. 

Exercise #1 –Sensory Stimulation

Bringing in sensory stimulation and strengthening the nerves in the bottom of the feet is important to overall movement function.   

Foot sensory stimulation can be in the form of textured insoles or socks, such as those by Naboso, vibration platforms and rollers, and barefoot stimulation.  These products can be used throughout the day or integrated in 30 minute doses.

When going barefoot or using sensory-based products always perform a foot check before and after to ensure that the foot skin is clean and in-tact.

This simple exercise is one that connects our postural muscles to our feet.    Start by standing barefoot on a clean surface, placing feet shoulder width apart. Keeping the body tall and straight, start to gently shift or lean the bodyweight forward until you feel the feet engaged and the toes push down into the floor. 

After you feel the toes engage, resume your starting position and relax the feet.   Repeat the forward lean 10 times.

This exercise trains all sensory input systems which are needed for balance including the visual, vestibular, proprioceptive and tactile.   

Start by sitting in a chair with your feet flat on the ground.  Stand up from the chair and turn in a full circle in one direction then sit back down.  Repeat by standing up and turning in a full circle in the other direction and sitting back down.

Repeat 5 times in each direction.  When turning go as slowly as you feel comfortable and ideally perform this exercise barefoot to increase foot stimulation.

Exercise #4 – Eye Movement Exercises

This series of eye movement exercises can be done sitting in a chair or standing for an increase challenge. 

For the first eye movement exercise you are going to hold a pen in one hand directly in front of you and with the arm straight out.  Slowly move the pen side to side or in figure 8 and track it with your eyes only.  Try to keep the head still so only the eyes are moving.   

Perform for 10 seconds with the pen in one hand and then repeat holding the pen in the other hand.

The second eye movement exercise is called a saccade.  To do this exercise you want to keep the head still, shift only the eyes and look all the way to the right and then all the way to the left.   Repeat back and forth, right to left for 10 seconds.     

Rest for 10 seconds and repeat for another 10 seconds.

The final eye movement exercise is targeted at strengthening the peripheral vision. In a seated or standing position, focus your gaze all the way across the room and stare at one object in the far distance.  While keeping the eyes locked on this object, start to notice other objects in the room that can be found in your peripheral vision.

Do not turn your head or shift your gaze when noticing the objects in the peripheral vision.  Perform for 30 seconds.

When performed consistently, all of these exercises have been shown to improve body awareness and postural perception when standing and walking.    Together our feet, posture, vestibular and visual system all play an important role in maintaining balance.  

For those with peripheral neuropathy and decreased sensation in the feet, training all these input systems is important to ensuring movement longevity.