Introduction

Distal symmetrical polyneuropathy is a peripheral neuropathy seen in patients with diabetes. It can cause symptoms such as pain, dysaesthesia, numbness or allodynia; however, patients may experience no symptoms at all if there is loss of protective sensation (insensate neuropathy). Some patients experience both symptoms and loss of protective sensation, known as the painful insensate foot. A key feature of distal symmetrical polyneuropathy is that abnormalities are bilateral and symmetrical, with progressive loss of sensation from the toes upward; unilateral abnormalities are usually not associated with diabetes. Loss of sensation significantly increases the risk of foot problems such as biomechanical abnormalities, ulceration and Charcot arthropathy.

Early identification of distal symmetrical polyneuropathy is an important part of diabetes management. Regularly assess patients with diabetes for signs and symptoms and loss of protective sensation. For details, see Screening for peripheral neuropathy.

Management of distal symmetrical polyneuropathy in patients with diabetes involves treatment of pain, foot care and optimisation of the glycaemic profile.