Do you ever have legs and / or feet that feel numb?
Yes
No
Do you ever have burning pain in your legs and / or feet?
Yes
No
Are your feet too sensitive to touch?
Yes
No
Do you get muscle cramps in your legs and / or feet?
Yes
No
Do you ever get prickling or tingling feelings in your legs or feet?
Yes
No
Does it hurt at night or when the covers touch your skin?
Yes
No
When you get into the tub or shower, are you unable to tell the hot water from the cold water?
Yes
No
Do you ever have sharp, stabbing, shooting pain in your feet or legs?
Yes
No
Have you experienced an asleep feeling or loss of sensation in your legs or feet?
Yes
No
Do you feel weak when you walk?
Yes
No
Are you symptoms worse at night?
Yes
No
Do your legs and / or feet hurt when you walk?
Yes
No
Are you unable to sense your feet when you walk?
Yes
No
Is the skin on your feet so dry that it cracks open?
Yes
No
Have you ever had electric shock-like pain in your feet or legs?
Yes
No
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