Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Diabetic peripheral neuropathy is present in more than 50% of people who have had diabetes for 10 or more years — making it one of the most common complications of the disease and one of the most serious threats to foot health. Understanding what it is, how it progresses, and what podiatric care can do to prevent its worst consequences is essential for every patient with diabetes.

What Is Diabetic Peripheral Neuropathy?

Peripheral neuropathy refers to damage to the peripheral nervous system — the vast network of sensory, motor, and autonomic nerves that extend from the spinal cord to the limbs. In diabetes, chronically elevated blood glucose levels damage the small blood vessels (microangiopathy) that supply these nerves, gradually starving them of oxygen and nutrients. The result is progressive nerve dysfunction that typically begins in the feet and works upward in a “stocking-glove” pattern.

Diabetic peripheral neuropathy affects three types of nerve fibers:

• Sensory nerves: Damaged sensory nerves produce numbness, tingling, burning, and loss of protective sensation — the crucial ability to feel pain, temperature, and pressure that normally protects the feet from injury.
• Motor nerves: Motor nerve damage weakens the intrinsic foot muscles, producing muscle atrophy, claw toe and hammertoe deformities, and altered gait mechanics that redistribute plantar pressure onto high-risk areas.
• Autonomic nerves: Autonomic neuropathy reduces sweat and oil gland function, causing dry, cracked skin that is prone to fissuring and infection. It also disrupts blood flow regulation, causing abnormally warm feet that may paradoxically be under-perfused.

Symptoms of Diabetic Peripheral Neuropathy in the Feet

Symptoms vary widely based on which nerve fibers are most affected and how advanced the neuropathy is:

• Numbness or reduced sensation in the feet and toes — the most dangerous symptom, as it eliminates protective pain signals
• Tingling, pins-and-needles sensations, particularly at night
• Burning pain, electric shocks, or hypersensitivity where light touch is painfully amplified
• Difficulty feeling heat, cold, or sharp objects with the feet
• Reduced balance and proprioception, increasing fall risk
• Dry, cracked, or unusually warm skin on the feet
• Muscle wasting (atrophy) visible in the arch and between the toes
• Progressive hammertoe, claw toe, or flatfoot deformity

Why Neuropathy Makes Foot Injuries So Dangerous

The loss of protective sensation is the central mechanism that turns minor injuries into life-threatening complications. A person without neuropathy immediately feels pain from a blister, a pebble in their shoe, or stepping on a sharp object — and removes the offending stimulus. A person with advanced neuropathy may walk for days on a penetrating wound, developing deep tissue infection and osteomyelitis before ever noticing a problem.

Studies demonstrate that diabetic patients with significant peripheral neuropathy have a 7-fold higher risk of foot ulceration compared to those without neuropathy, and diabetic foot ulcers precede approximately 85% of all diabetes-related amputations.

The Annual Diabetic Foot Exam: What It Includes

The annual comprehensive diabetic foot exam performed by a podiatrist is one of the most powerful preventive interventions available:

• Monofilament testing: A 10-gram nylon filament is pressed against specific plantar sites to assess protective sensation. Failure to feel the monofilament at two or more sites indicates significant neuropathy and dramatically elevated risk.
• Vibration threshold testing: Assesses large nerve fiber function, often the first modality affected in early neuropathy.
• Vascular assessment: Palpation of pedal pulses and ankle-brachial index (ABI) measurement screens for peripheral arterial disease, which compounds neuropathy risk.
• Dermatological examination: Identifies pressure ulcers, pre-ulcerative calluses, fissures, fungal infections, and other skin pathology requiring intervention.
• Biomechanical evaluation: Identifies structural deformities (hammertoes, bunions, Charcot changes) that create pressure points.
• Footwear assessment: Reviews shoe fit and appropriateness, and initiates Medicare therapeutic footwear prescriptions when indicated.

Medicare Coverage for Diabetic Foot Care

Medicare covers one comprehensive diabetic foot examination per year for beneficiaries with diabetes and documented peripheral neuropathy. Medicare also covers therapeutic footwear (one pair of depth shoes and three pairs of custom inserts per year) when prescribed by a treating physician and dispensed by an appropriately licensed provider.

Diabetic Neuropathy Foot Care in Howell & Bloomfield Hills

Experiencing numbness, tingling, or burning in your feet? Our podiatrists specialize in diabetic peripheral neuropathy management with comprehensive foot exams and protective care plans.

Learn About Our Diabetic Foot Care Program → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Pop-Busui R, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care, 2017;40(1):136-154.
2. Boulton AJ, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care, 2005;28(4):956-962.
3. Tesfaye S, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care, 2010;33(10):2285-2293.

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.