Diabetic Peripheral Neuropathy

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  • Introduction

    DPN is “The presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes”. In diabetic foot disease; diabetic peripheral neuropathy (DPN) is the primary risk factor for the development of diabetic foot ulcers. DPN is one of the most common diabetes complications and it significantly impacts progression to the devastating outcomes of ulcerations that may lead to amputations.

    Diabetic foot ulcers (DFUs) often co-exist with vascular insufficiency and are the major cause of gangrene and amputation in people with diabetes. Risk of developing diabetic foot ulcers is greatly increased by reduced sensation and blood perfusion.

    The reported prevalence of diabetic peripheral neuropathy ranges from 16% to as high as 66% and it is believed to increase with the duration of diabetes and poor glucose control.

  • Diagnosis of Peripheral Neuropathy

    Peripheral neuropathy requires Diabetic Foot screening. The various types include

    1. Touch pressure sensation
    The various areas are checked on the feet for sensation and are marked accordingly on the diagram below.

    2. Test for Vibration Loss:
    The patient is first given a demo on a bony prominence of the wrist and then it is tested on the feet using a 128 – Hz tuning fork in this test.

    3. Measure Vibration perception threshold (VPT)
    The VPT is measured by a sensitometer that uses voltage on the soles of the patient.

    4. Test temperature sensation
    Temperature is measured for understanding sensation on the feet.

    5. Pain sensation
    Stinging, burning and aching pain is evaluated using a TSS score

    6. Check for ankle reflex
    The doctor checks on easy movement and flexibility of the ankle.

    7. Vibrotherm (Vibration, Pressure, Thermal- Diabetes Neuropathy):
    Diabetes often damages peripheral nerve endings so are checked for numbness at their extremities.

    8. Vascular Doppler – Diabetes Vasculopathy:
    A patient with diabetes and PVD is more likely to present with an ischaemic ulcer or gangrene than a patient without diabetes. Therefore, Ankle Brachial pressure Index (ABI) is used to provide a measure of blood flow to the ankle.

    9. Podia scan 
    Podia scan identifies structural defects and the high pressure points on the foot (sole) and helps to resolve abnormal foot positions to avoid non-healing foot ulcers.

  • Treatment

    1. Comprehensive diabetic foot assessment with Risk Categorisation

    A comprehensive diabetic foot assessment consists of five elements,

    Inspection - Evaluation including determining the footwear

    Dermatologic - Examining skin, infections, ulcerations, calluses, blistering

    Musculoskeletal - Checking for deformities and muscle wasting

    Neurological - Using vibration 128 Hz tuning fork, pinprick sensation, ankle reflexes or vibration perception threshold testing (VPT)

    - Vascular – Determining ankle brachial pressure index (ABI) With all/any of the above the rick can be categorized.

    2. Management of foot problems
    Regular foot care management includes removal of corn and callus, treatment of fungal infection and Tinea Pedis in persons with diabetic condition. While only a cosmetic nuisance for most, in the diabetes population there is a likelihood of secondary complications leading to amputation by compromised vascular status and DPN.

    3. Patient education and daily self-inspection
    Patients with diabetes need to take extra care and self-inspect their feet and lower extremities. Here are a few tips they require to follow -

    • Inspect both feet daily, including the area between the toes.
    • Wash the feet daily with water at room temperature and dry thoroughly.
    • Use lubricating oils or creams for dry skin, but not between the toes.
    • Cut nails straight across.
    • Do not remove corns and calluses using a chemical agent or plaster. They should not be excised at home and must be managed by trained staff.
    • Always wear socks with shoes and check inside shoes for foreign objects before wearing them.
    • Avoid walking barefoot at all times.
    • Ensure a qualified healthcare provider examines your feet regularly.


    For a Comprehensive diabetic foot assessment Wound & Vein, the diabetic clinic in Mumbai is equipped with advanced techniques in diabetes footcare.

    Our team specialists in diabetic footcare in Mumbai are here to help you. Call us today for an appointment.

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