What is Epidermal Nerve Fiber Density (ENFD) testing

Epidermal Nerve Fiber Density (ENFD) testing is the analysis of a 3mm punch biopsy of skin to quantify the number of unmyelinated C-fibers and myelinated A delta-fibers within the epidermis.

The skin has a rather consistent number of epidermal nerves at specific anatomical sites. This density is also found to be consistent between different age groups and genders. Small fiber peripheral neuropathy is indicated when this density runs below the normal curve. Also, prior to the onset of symptoms, degeneration within the epidermal nerves may predict peripheral neuropathy.

ENFD is not new technology actually; neurologists have used this technique for over 15 years. Peripheral neuropathy begins with the body’s smallest and most distal nerves, which are the C-fibers and A delta-fibers, and then progresses proximally in a stocking-like distribution.

Epidermal Nerve Fiber

Some most common causes of small fiber peripheral neuropathy include:

  • Diabetes mellitus, Type I and II
  • Metabolic syndrome
  • Idiopathic/familial
  • Alcohol abuse
  • Human Immunodeficiency Virus
  • Amyloidosis
  • Pharmacologic toxins (metronidazole)
  • Solvent exposure
  • Chemotherapy-induced
  • Leprosy
  • Vasculitis
  • Autoimmune (various disorders)

Advantages of ENFD

  • Purely objective measure of small nerve disease
  • Possibly might be able to predict neuropathy
  • Easily performed in an office setting
  • Provides a baseline so that the benefits of therapeutic agents may be measured
  • Highly specific and sensitive
  • Quick and easy to perform

For an appointment with one of our doctors at one of our nine Southern California locations please call 310-828-0011 or visit us at www.footankleinstitute.com

One comment

  1. I’ve been searching all over the place for more info on ENFD and came across your article.
    What a perfect web-site.

    Thanks for sharing superb information. Your web site is so cool. I’m impressed by the details that you have on this site. I bookmarked it, I will be back.

Leave a Reply

Your email address will not be published.

17 − six =

  • CustomerSure
    Suzanne & her staff are not only professional at all times during my treatment, but are very thoughtful and caring.
    Frank G.
  • Yelp
    Best doctor hands down. He has helped me so much, and he actually cares about you and wants the best for you.
    Gina V.
  • Yelp
    I found Dr. Franson for a second opinion, after seeing an orthopedic specialist who misdiagnosed me and was about to cut my foot and ankle open. Dr. Franson put me at ease and ordered the appropriate MRI, which the ot...
    C.M.
  • Yelp
    I had an absolutely great experience with Dr. Morris at this office.  I had a bad ankle/foot injury and although initially they didn't have an appointment available for several days later, they heard my case and agree...
    Matthew D.
  • Yelp
    Wow! I have just scrolled down and read through numerous reviews and they are certainly all over the map ! After reading, I felt the strong need to share my family's and friend's multiple satisfying experiences with D...
    Lorna B.
  • CustomerSure
    Everything about the office was clean, efficient and professional.
    Ronald G.
  • Yelp
    Communication is easy with all levels of staff. I love the reminders that are done via computer. There are a lot loose ends in my day, and the reminders help me stay organized.
    Sharon E.
  • Yelp
    I am so grateful for Dr. Campbell!  He is very knowledgeable, skilled, thorough, and patient. His warm, friendly demeanor always keeps me calm (which is amazing for someone who gets as anxious as I do)!  During my f...
    Amanda S.
  • Yelp
    Went to another podiatrist for months before seeing Dr. Bob Baravarian.  The Foot & Ankle Institute is run like a well oiled machine.  I got an appointment quickly, he identified my issue in 2 minutes, treated me, and...
    Sean W.
  • CustomerSure
    I am not kept waiting. Communication is easy with all levels of staff. I love the reminders that are done via computer, in that there are a lot loose ends in my day, and the reminders help me stay organized without h...
    Sharon E.
Same day appointments now available!
or call 24/7:
  • University Foot & Ankle, a Preferred Provider to:
  • UCLA Health System - UCLA Medical Group
  • MPTF - Member Industry Health Network
  • Cirque du Soleil
  • ATP - Association of Tennis Professionals
  • And consulting physicians for:
  • C&S - Cedars-Sinai
  • Saint John's Health Center