Show Notes
The patient passes the foot exam, then tells you their toes burn at night. We read a new American Limb Preservation Society paper on putting the neuropathy guidelines into practice alongside the review it cites eight times, and ask why it never mentions corneal confocal microscopy, the tool that review calls "the most pertinent modality for early detection".
In this episode: - Why small nerve fibres matter: the earliest to degenerate, with the greatest potential for repair - Corneal confocal microscopy in plain terms, the idea of screening corneal nerves alongside diabetic eye screening, and the caveats its own authors give - Why the 10 g monofilament is not recommended as the sole test to diagnose neuropathy - Scoring tools: TCNS, MNSI and NDS - Five risk classification schemes side by side, and why a clinic should pick one (we walk through IWGDF) - Footwear, skin temperature monitoring and supplements - Painful neuropathy: reduction not elimination, and when to switch drug class - Opioids, and the ADA's view of tramadol and tapentadol - Why the implementation section is the weakest part of the paper - Three changes for Monday
Chapters: 00:00 Cited eight times, and one omission 01:25 Small fibres: first to go, first to recover 02:44 What the paper cites the review for 03:54 Corneal confocal microscopy in plain terms 05:53 "The most pertinent modality for early detection" 06:31 The caveats 08:07 Scoring tools: TCNS, MNSI and NDS 08:56 The monofilament: not the sole test 10:12 Ruling out peripheral artery disease 10:44 Risk classification: five schemes, pick one 13:33 Footwear and skin temperature monitoring 14:35 Supplements 15:14 Painful neuropathy: reduction, not elimination 16:40 When a drug fails: same class or a different class 17:29 Opioids 18:11 Implementation: the weakest section 19:00 Author disclosures 19:28 Three changes for Monday 20:38 Closing thought: an eye scan before the foot clinic
Sources: Burgess J, Frank B, Marshall A, et al. Early Detection of Diabetic Peripheral Neuropathy: A Focus on Small Nerve Fibres. Diagnostics (Basel). 2021;11(2):165. Open access. DOI: 10.3390/diagnostics11020165
Rogers LC, Lepow BD, Armstrong DG, et al. Diabetic Peripheral Neuropathy: Implementing Guidelines into Practice. J Am Podiatr Med Assoc. 2026;116(5):84. Open access. DOI: 10.3390/japma116050084
Free for clinicians: the Teaching Document for LimbWise Module A1, Foundations of the Diabetic Foot. https://store.thefootindiabetes.com/free/a1?utm_source=spotify
This episode is for education only. It is not medical advice and does not replace your own clinician or your local protocols.
The voices in this episode are AI-generated (Google NotebookLM), discussing the two papers above. The episode was reviewed by Rob Menzies, who is responsible for its content.
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