If you have diabetes, your feet deserve more attention than you might realize. One of the most common — and most underestimated — complications of diabetes is diabetic peripheral neuropathy (DPN): nerve damage that quietly affects the feet and legs. What makes DPN particularly dangerous is that up to 50% of people who have it experience no symptoms at all. By the time pain, tingling, or numbness appear, significant nerve damage may already have occurred.
The good news is that early detection and proactive care can dramatically reduce your risk of serious complications, including foot ulcers and amputation. At The Mayer Institute, our podiatric team specializes in identifying neuropathy early — before it becomes a crisis.
What Is Diabetic Peripheral Neuropathy?
Diabetic peripheral neuropathy is nerve damage caused by prolonged high blood glucose levels. Over time, excess sugar damages the small blood vessels that supply your nerves, gradually impairing their ability to transmit signals properly. The feet and lower legs are most commonly affected because the nerves there are the longest and most vulnerable.
DPN can affect different types of nerve fibers:
- Sensory nerves — responsible for feeling pain, temperature, pressure, and touch
- Motor nerves — controlling muscle movement and balance
- Autonomic nerves — regulating sweating and skin moisture
When sensory nerves are damaged, you may lose the ability to feel a blister, a small cut, or excessive pressure from your shoe. Without that warning signal, minor injuries can go unnoticed and quickly escalate into serious infections or non-healing wounds.
Why Early Detection Is So Critical
The 2024 and 2025 Standards of Care in Diabetes from the American Diabetes Association (ADA) are clear on this point: all patients with type 2 diabetes should be screened for DPN at the time of diagnosis, and those with type 1 diabetes should be screened after five years of living with the condition. Annual screening is then recommended for everyone going forward.
The reason for this urgency? Neuropathy is often already well-established by the time symptoms develop. Early-stage small fiber damage — which affects the thinnest nerve fibers responsible for pain and temperature sensation — frequently goes undetected by routine tests. A 2024 multidisciplinary expert consensus published in Frontiers in Endocrinology emphasized that a multimodal screening approach is needed to catch DPN in its earliest, most treatable stages.
Research published in Drugs & Aging (2025) highlights an exciting frontier: new diagnostic technologies such as corneal confocal microscopy (CCM), DPNCheck, and Sudoscan are capable of detecting small fiber neuropathy before standard clinical tests show any abnormality. These tools are increasingly being integrated into specialized diabetic foot clinics, offering patients the chance to intervene much earlier than ever before.
How Neuropathy Is Screened and Assessed
A thorough diabetic foot examination remains the cornerstone of neuropathy screening. At The Mayer Institute, our assessments include:
- 10-gram monofilament test — a simple, validated tool to detect loss of protective sensation (LOPS). If you cannot feel the filament when pressed against the sole of your foot, you are at significantly elevated risk for foot ulcers.
- Vibration perception testing — using a 128-Hz tuning fork to assess large-fiber nerve function
- Pinprick and temperature sensation tests — evaluating small fiber nerve integrity
- Ankle reflex assessment — checking for motor nerve involvement
The ADA recommends using the monofilament test together with at least one additional neurological assessment to improve accuracy and ensure nothing is missed. No single test tells the whole story — which is why a comprehensive, in-person examination by an experienced clinician matters so much.
Prevention Starts With Blood Sugar Control — and a Foot Care Team
The most powerful way to slow or prevent diabetic peripheral neuropathy is tight, consistent blood glucose management. A comprehensive review in World Journal of Diabetes (2025) confirms that optimizing glycemic control remains the most effective form of secondary prevention — reducing both the risk of developing neuropathy and the rate at which it progresses in those who already have it.
But blood sugar control alone is not enough. A multidisciplinary approach — bringing together your diabetes care team, podiatrist, vascular specialist, and, when needed, wound care experts — is the gold standard for preventing foot complications. Key preventive strategies include:
- Annual or more frequent foot examinations with a podiatric specialist
- Proper footwear and custom orthotics to redistribute pressure and prevent ulceration
- Daily self-inspection of your feet for cuts, blisters, redness, or swelling
- Skin care to prevent dryness and cracking (a common entry point for infection)
- Avoiding barefoot walking, especially outdoors
Emerging technologies — including wearable sensors that detect temperature changes in the foot, mobile health apps, and telehealth platforms — are also being studied as tools to help patients monitor their feet between clinic visits, further closing the gap between appointments.
Do Not Wait for Symptoms — Take Action Now
Diabetic peripheral neuropathy does not have to lead to ulcers, infections, or amputation. When caught early and managed comprehensively, the risks can be dramatically reduced. The challenge is that waiting for symptoms means waiting too long.
At The Mayer Institute, we provide specialized diabetic foot assessments using evidence-based screening tools and a patient-centred approach. Whether you have recently been diagnosed with diabetes or have been managing it for years, a thorough foot examination is one of the most important steps you can take for your long-term health.
Contact The Mayer Institute today to schedule your diabetic foot assessment. Early action is the best protection.
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