Neurologic evaluation and treatment of the diabetic foot

Neuropathy is a frequent complication of diabetes and is most commonly manifest as a sensory neuropathy involving the feet. Although biochemical and experimental animal studies suggest a direct link between the hyperglycemia of diabetes and the development of neuropathy, this link is unproven in humans. Evaluation for neuropathy can usually be accomplished clinically, but in selected cases electromyography is helpful. Other testing methods have a well-defined research note, but their clinical utility is less well established. Treatment of diabetic neuropathy is empirical. Better blood glucose control is attempted and a variety of medications are used to treat the symptoms. Promising treatment methods are being investigated, but none is of proven benefit.