Neuropathy

Diabetes—and the neuropathy associated with it—is one of the most common reasons for foot amputations in the world. Having a well performed foot exam on a regular basis (at least annually)—with appropriate neurovascular and skin assessment—can identify patients who are either at risk of skin breakdown or who already have skin breakdown and ulcers. While podiatrists specialize in the care of the diabetic foot and can perform a screening foot exam, it is within the purview of the primary care physician to do this screening exam on a regular basis. To achieve high rates of screening, office practices should consider organizing themselves around team-based care. In this setting, the patient is engaged and understands the expectation to take shoes and socks off for each visit, the medical assistant or registered nurse reminds the patient to do so and ensures there is a monofilament in a standard spot in the exam room, and the doctor performs and documents the exam in a standard location. Below are examples of some additional resources to assist practices in improving.

Neuropathy Resources

Resource Link Brief Description of Resource
Management of Diabetic Peripheral Neuropathy Article: American Diabetes Association, Clinical Diabetes

An article outlining the management of diabetic peripheral neuropathy.
Microvascular Complications and Foot Care Article: American Diabetes Association, Diabetes Care

An article identifying microvascular complications and foot care.
Diabetes Foot Care Training (PDF, 392 KB) Training manual: Indian Health Service Division of Diabetes Treatment and Prevention

Instruction on diabetes foot assessment and patient education materials.
Treatment of Painful Diabetic Neuropathy (PDF, 1019 KB) Article: American Academy of Neurology (AAN)

A summary of the guideline update regarding pharmacologic and nonpharmacologic treatment of painful diabetic neuropathy (PDN).
Working Together to Manage Diabetes: A Guide for Pharmacy, Podiatry, Optometry, and Dentistry (PPOD) (PDF, 428 KB) Resource: NDEP PPOD Guide

Links to a sampling of resources for pharmacy, podiatry, optometry, and dentistry (PPOD) specialties.
Lower Extremity Amputation Prevention (LEAP) Toolkit: Agency for Healthcare Research and Quality (AHRQ)

Lower Extremity Amputation Prevention (LEAP) is a comprehensive program that can dramatically reduce lower extremity amputations in individuals with diabetes mellitus, Hansen’s disease, or any condition that results in loss of protective sensation in the feet.