If you live with diabetes, you may have heard your doctor mention neuropathy — but do you know what it really means for your feet, and why catching it early can be the difference between keeping a limb and losing one? Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes, and it quietly sets the stage for foot ulcers, infections, and amputations. The good news is that with the right monitoring and care, its worst consequences are largely preventable.
What Is Diabetic Peripheral Neuropathy?
Diabetic peripheral neuropathy is nerve damage caused by prolonged exposure to high blood glucose levels. It primarily affects the longest nerves in the body — those that travel from the spine down to the feet. Over time, persistently elevated blood sugar damages the tiny blood vessels that feed these nerves, gradually impairing their ability to transmit sensory signals.
The result is a loss of protective sensation: the ability to feel pain, temperature, pressure, and vibration in the feet. This is not merely uncomfortable — it is dangerous. A person with advanced neuropathy may step on a nail, develop a blister from ill-fitting shoes, or sustain a burn from hot water and feel nothing at all, allowing an injury to progress undetected for days or weeks.
How Common Is It — and How Serious?
The numbers are sobering. Diabetic peripheral neuropathy eventually affects nearly 50% of all adults with diabetes during their lifetime, yet up to half of those affected have no symptoms at the time of diagnosis. A 2024 study published in Scientific Reports confirmed that neuropathy remains one of the strongest independent risk factors for lower-limb amputation in people with diabetes.
Globally, approximately 6.4% of people with diabetes develop diabetic foot ulcers, and of those, 14–24% ultimately require amputation. The American Diabetes Association's 2025 Standards of Care note that peripheral sensory neuropathy is the single most common contributing cause of foot ulceration — present in 78% of cases. The triad of neuropathy, minor trauma, and foot deformity was identified in more than 63% of study participants with ulcers. Effective preventive foot care, including structured patient education, has been shown to reduce ulcer and amputation rates by as much as 50%.
What Does a Comprehensive Diabetic Foot Exam Involve?
The ADA and leading podiatric guidelines recommend that all people with diabetes receive a comprehensive foot examination at least once per year — and more frequently for those in higher-risk categories. At The Mayer Institute, our foot examinations go well beyond a quick visual check. A thorough assessment includes:
- Monofilament testing to assess loss of protective sensation at multiple sites on the sole
- Vibration perception testing using a 128-Hz tuning fork at the great toe and malleoli
- Ankle reflex assessment for signs of large-fibre nerve involvement
- Inspection of skin integrity, calluses, deformities, nail health, and interdigital spaces
- Vascular assessment including palpation of pedal pulses and Ankle-Brachial Index (ABI) measurement when indicated
- Footwear evaluation to identify sources of pressure, friction, or inadequate support
According to the ADA 2025 Standards of Care, screening should begin at diagnosis for people with type 2 diabetes and after five years of living with type 1 diabetes. Annual screening thereafter is essential — even if the patient feels fine, because the absence of symptoms does not mean the absence of damage.
Treatment Options: From Proven Therapies to Emerging Innovations
While there is currently no cure for diabetic peripheral neuropathy, several approaches can slow its progression and meaningfully relieve its symptoms.
Glycaemic optimisation remains the cornerstone of DPN management. Keeping blood glucose as close to target as possible — in discussion with your diabetes care team — directly reduces the rate of nerve damage. This is especially true in type 1 diabetes, where tight glucose control has been shown to reduce neuropathy incidence by more than 60% in landmark trials.
Pharmacological pain management for painful DPN is guided by current U.S. and international guidelines. The American Society of Pain and Neuroscience (ASPN) 2024 guidelines and a comprehensive 2024 review in the Journal of Pain Research identify first-line options including duloxetine (an SNRI), pregabalin or gabapentin (gabapentinoids), and amitriptyline (a tricyclic antidepressant). A high-concentration capsaicin patch (8%) is also FDA-approved for topical management. These medications do not repair nerves, but they can substantially reduce burning, shooting, and aching pain, improving sleep and quality of life.
Emerging device-based therapies are expanding options for patients who do not respond adequately to medications. In 2024, the FDA cleared Axon Therapy's magnetic peripheral nerve stimulation (mPNS) device specifically for painful DPN — a non-invasive outpatient treatment delivering targeted magnetic pulses to damaged peripheral nerves. Spinal cord stimulation (SCS) devices have also received FDA clearance for refractory painful DPN, offering meaningful relief for carefully selected patients. These developments, highlighted in a 2025 review in Drugs & Aging, represent a significant step forward for patients whose pain is inadequately controlled by oral medications alone.
What You Can Do Starting Today
You do not need to wait for a specialist appointment to start protecting your feet. These daily habits are evidence-based and straightforward:
- Inspect your feet every day — top, bottom, and between the toes — using a mirror or asking a family member if needed
- Wash feet daily in warm (not hot) water; check the temperature with your elbow, not your foot
- Moisturize the soles but keep cream out of the spaces between toes to prevent fungal growth
- Never walk barefoot — indoors or outdoors
- Wear well-fitted, cushioned footwear and inspect shoes before putting them on each time
- Trim toenails straight across and file any sharp edges
- Report any new cut, blister, redness, or wound to your podiatrist promptly — do not attempt to self-treat
Take the Next Step with The Mayer Institute
Diabetic peripheral neuropathy is a serious condition, but it is one that can be managed with the right team by your side. At The Mayer Institute, our experienced podiatric specialists provide comprehensive diabetic foot assessments, personalized risk stratification, and evidence-based care designed to keep you mobile, active, and limb-intact.
Do not wait for a wound to develop before seeking care. Early detection and regular monitoring are your most powerful tools. Contact The Mayer Institute today to schedule your annual diabetic foot examination — because protecting your feet starts with a single appointment.
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