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

The UFAI Education Team

The UFAI Education Team

For almost fifteen years, University Foot and Ankle Institute and their nationally recognized physicians have been providing the most technologically advanced medical care for the foot and ankle with the highest success rates in the country.

As a teaching institution, University Foot and Ankle Institute’s Fellowship Program is among the most advanced in the nation.

We at UFAI are driven to get our patients back to their normal activities with the highest level of function, in the least amount of time, using the least invasive treatments possible. From start to finish, we are with you every step of the way.

The UFAI Education Team works to help empower our patients and website visitors with the most up-to-date information about foot and ankle conditions, treatment options, recovery and injury prevention. Our goal is to pass on truly useful information to our readers.

We hope you enjoy our work and find it of value. Please let us know!
The UFAI Education Team

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.

Over 200,000 happy UFAI patients and growing
  • CustomerSure
    Everyone is nice & friendly, which helps a lot. Also they do great work!
    Hannah C.
  • CustomerSure
    Excellent service. Dr. Bob is fantastic!
    Dana M.
  • CustomerSure
    I've had two Lapidus Bunionectomy surgeries (one for each foot) by Dr Baravarian and I'm thrilled with the results. My bunions were extreme and required extreme expert measures to correct them. Dr. Baravarian is one o...
    Ryan
  • CustomerSure
    Very helpful that my doctor plays hockey since I had a hockey injury!
    Kristina W.
  • Thank you for all your care and support. After 5 years of pain, you took care of things permanently for me. I can't tell you what a joy it is to be able to walk or simply pick up my kid and not be in pain. I'm foreve...
    Miriam
  • CustomerSure
    Exceptional care! The therapist really pays you personal attention. Something I especially liked was being asked my expectations for physical therapy at the onset of the treatment.
    Benji M.
  • Yelp
    So fortunate to have found Dr Franson. I was treated by him last year for a torn achilles tendon, and today my daughter was treated by him. She's pregnant and he was very attentive to her concerns about treatment for ...
    S.K.
  • Yelp
    Dr. Brayton Campbell is a very knowledgeable podiatrist.  It is obvious he cares about his patients to make sure we receive the right care.  I am very glad I have him as my podiatrist!
    Carole K.
  • CustomerSure
    Your institute is one of the best!
    Hana A.
  • CustomerSure
    I have already recommended Dr Baravarian to my friend Lynn. Thank you so much. Great staff is everything, and you were awesome and sweet!
    Debbie T.
Same Day Appointments
Now Available!

Or call 877-989-9110

24 hours a day, 7 days a week