- Diabetic neuropathy is nerve damage caused by long-term diabetes, most commonly affecting the feet.
- Symptoms range from numbness and tingling to burning pain — but the most dangerous version is loss of protective sensation, where you can't feel injury.
- Treatment focuses on optimal blood sugar control, symptom management, and aggressive prevention of foot complications.
- Regular podiatry care every 2–3 months for high-risk diabetic patients is the single most effective way to prevent ulcers and amputations.
- Our diabetic foot program at our Hoyt office is led by Dr. Cara Beach, with care available at all 8 clinics.
What is diabetic neuropathy?
Diabetic peripheral neuropathy is the most common complication of long-term diabetes. Persistently elevated blood sugar damages the small nerves that supply the feet (and eventually the hands), leading to a progressive loss of normal nerve function. About half of people with diabetes will develop some form of peripheral neuropathy in their lifetime, and the risk rises significantly the longer a person has had diabetes.
Neuropathy presents differently in different patients. Some have painful neuropathy — burning, tingling, or shooting pains, often worse at night. Others have the more dangerous "silent" version: loss of protective sensation, where they cannot feel a small cut, a hot floor, or a pebble in their shoe. Patients with loss of protective sensation are at very high risk for foot ulcers, infections, and ultimately amputation if they don't have regular preventive foot care.
At Northwest Extremity Specialists, our diabetic neuropathy care has two parallel goals: managing symptoms (where present) and preventing the complications that put limbs at risk. Patients with documented neuropathy are typically seen every 2–3 months for a comprehensive diabetic foot exam, professional nail and callus care, footwear assessment, and patient education. Our program is led by Dr. Cara Beach at the Hoyt office, and the same model is available at all of our other locations.
See it in motion
Animations licensed from ViewMedica · Swarm Interactive
What it feels like
Diabetic neuropathy can be either painful or silent. Common features:
- Numbness or reduced sensation in the toes and feet
- Tingling, burning, or "pins and needles" sensations
- Shooting pains, especially at night
- Loss of position sense — feet feel "wooden" or unsteady
- Inability to feel hot or cold water with the feet
- A pebble or wrinkle in your sock that you don't notice
- Calluses or wounds you can't feel forming
- Difficulty maintaining balance
- Changes in the shape of the foot (Charcot changes in advanced cases)
Why it develops
Diabetic neuropathy is caused by chronic exposure of nerve tissue to elevated glucose. Contributing factors:
- Years of diabetes — risk rises significantly after 10+ years
- Poor glycemic control (high A1c)
- Smoking, which damages small blood vessels
- High blood pressure and high cholesterol
- Excess alcohol use
- Genetic predisposition
- Other nerve-damaging conditions layered on diabetes
How we diagnose diabetic neuropathy
Diabetic neuropathy is diagnosed through a careful history and a structured foot exam. Key tests include monofilament testing (a soft plastic filament pressed against various spots on the foot to check protective sensation), vibration testing with a tuning fork, reflexes, and pinprick sensation. Pedal pulses are checked to evaluate circulation in parallel, since vascular disease often coexists. Most patients receive a clear "risk stratification" — low, moderate, or high risk for foot complications — which guides how often they should be seen. On-site X-ray and vascular studies are used as needed.
Non-surgical care
Diabetic neuropathy management has two parallel tracks: symptom control (where there is pain) and complication prevention (always). The complication prevention side is what saves limbs:
- Regular podiatry visits — typically every 2–3 months for patients with documented neuropathy
- Professional nail and callus care to prevent skin breakdown
- Custom diabetic shoes and inserts (often covered by insurance under Medicare's therapeutic shoe program)
- Daily foot self-inspection training
- Coordination with primary care or endocrinology for optimal blood sugar control
- Smoking cessation support if applicable
- Medications for painful neuropathy (gabapentin, duloxetine, others — usually managed by primary care)
- Vascular evaluation and revascularization if circulation is impaired
- Aggressive treatment of any wound or callus before it becomes an ulcer
When to see a specialist
- Diabetes plus any new numbness, tingling, or burning in the feet
- A diabetic patient who has not had a foot exam in the past 12 months
- A high-risk diabetic patient (prior ulcer, neuropathy, vascular disease) without a regular podiatry schedule
- Any new wound, callus, blister, or skin change — even small ones
- A change in foot shape or new swelling without injury (could be Charcot foot — urgent)
Our diabetic neuropathy program is led by Dr. Cara Beach at our Hoyt office, with comprehensive diabetic care available at all 8 clinics. High-risk patients are typically seen every 2–3 months on a structured prevention schedule.