Understanding Diabetic Peripheral Neuropathy in Wound Care
February 5, 2026
Keywords
Categories
Key Takeaways:
1. Loss of protective sensation is the primary link between neuropathy and foot ulcers
Diabetic peripheral neuropathy reduces a patient’s ability to feel pressure, pain, and temperature changes, allowing minor injuries to progress into serious foot ulcers. Routine sensory testing is critical for identifying high-risk patients before wounds develop.
2. Neuropathy alters foot structure and pressure distribution
Motor nerve damage contributes to muscle imbalance and foot deformities that increase localized pressure points. These changes elevate ulcer risk and highlight the importance of footwear, offloading, and gait assessment in neuropathic patients.
3. Early detection and patient education significantly reduce complications
Consistent screening, daily foot inspection education, and interdisciplinary care help slow neuropathy progression and prevent infection, hospitalization, and diabetes-related amputations.
Diabetic peripheral neuropathy (DPN) is a common nerve disorder among people living with diabetes, and it represents a major contributor to foot complications such as loss of protective sensation, ulceration, infection, and limb loss. DPN affects the peripheral nervous system, leading to sensory, motor, and autonomic dysfunction that significantly increases the risk of wounds that are slow or difficult to heal.1
What Is Diabetic Peripheral Neuropathy?
DPN is a clinical condition arising from long-standing elevated blood glucose levels and metabolic dysregulation in diabetes. It can present with variable symptoms such as1:
-
Numbness or loss of sensation
-
Tingling, burning, or “pins and needles” sensations
-
Deep aching or sharp discomfort
-
Weakness or instability in the feet
Importantly, DPN often begins in small nerve fibers and progresses to larger sensory fibers that transmit vibration and pressure sensation. As nerve damage advances, the foot becomes less able to detect injuries, cuts, or pressure points; a key reason why foot wounds may go unnoticed until they worsen.1
Why DPN Matters in Diabetic Wound Care
Loss of Protective Sensation
One of the most profound clinical consequences of DPN is loss of protective sensation (LOPS) — the inability to feel minor trauma, pressure, or temperature changes on the plantar surface of the foot. In the absence of sensation, patients may unknowingly sustain repetitive microtrauma that evolves into ulcers.1 Because a patient cannot feel these injuries, breakdown can progress rapidly before clinical detection.
Cascade to Ulceration and Complications
When protective sensation is diminished1:
-
Calluses and pressure points develop without pain feedback.
-
Minor wounds deepen into diabetic foot ulcers (DFUs).
-
Ulcers often become infected and may track to deeper tissues like bone (osteomyelitis).
-
Reduced healing capacity further increases the risk of hospitalization and lower-extremity amputation.
Thus, DPN is not simply a neurological diagnosis — it is a primary driver of diabetic foot pathology that wound care professionals must actively identify and manage in clinical practice.
Clinical Assessment of Peripheral Neuropathy
Identifying neuropathy early is essential for preventing foot complications. DPN assessment should be systematic and include1:
1. Neurological History
Ask patients about symptoms such as numbness, burning, tingling, or unexplained foot pain, especially if symptoms are worse at night.
2. Sensory Testing
Clinical tools used in routine practice include:
-
10-gram monofilament testing to assess light touch and pressure perception
-
Vibration testing with a tuning fork for large-fiber function
-
Pinprick and temperature sensation to evaluate small-fiber integrity
These sensory testing methods help detect early nerve dysfunction that may not yet be clinically obvious.
3. Functional Evaluation
Assess gait stability and motor strength in the intrinsic foot muscles. Weakness due to neuropathy contributes to altered pressure distribution and foot deformities, increasing localized stress and ulcer risk.
Management of DPN: Implications for Wound Care
While nerve damage from DPN cannot be fully reversed, effective management strategies can reduce risk and slow progression. For wound care clinicians, these management principles help inform preventive care and multidisciplinary referrals1:
Patient Education. Teaching patients about daily foot inspection, proper nail care, and how to recognize early signs of injury empowers self-monitoring and early reporting of problems.
Glucose Control. Optimal blood glucose management slows the progression of neuropathy and reduces risk of additional nerve damage.
Footwear and Offloading. Patients with sensory loss may require protective footwear, custom insoles, and pressure-redistributing devices to minimize repetitive trauma. This approach is central to ulcer prevention and wound healing.
Multidisciplinary Care. DPN affects neurologic, metabolic, and structural aspects of the foot. Collaborating with endocrinologists, neurologists, podiatrists, physical therapists, and diabetes educators improves overall risk management and care coordination.
Signs that Require Urgent Evaluation
Certain findings in a patient with diabetic neuropathy should prompt urgent assessment and potential referral1:
-
New onset of severe foot pain or burning
-
Signs of skin breakdown or ulceration
-
Redness, swelling, or signs of infection
-
Loss of pedal pulses or cool extremities
These clinical cues suggest evolving foot pathology that warrants prompt intervention to prevent progression to deep ulceration or infection.
In Summary
DPN is a common and critical factor in diabetic foot pathology, responsible for loss of protective sensation that predisposes patients to foot wounds and ulcers. Through thorough assessment, patient education, risk stratification, and interdisciplinary care, wound care professionals can play a pivotal role in preventing ulcer development and reducing morbidity associated with diabetic foot complications.
Reference
Bodman M, Dreyer MA, Varacallo M. Diabetic Peripheral Neuropathy. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2025. PMID: 28723038. Accessed January 15, 2026.
The views and opinions expressed in this content are solely those of the contributor, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.
