Diabetic neuropathy: is pain God's greatest gift to mankind?

Diabetic neuropathy is common and it has been estimated that around 40% of older type 2 diabetic patients have risk factors for foot ulceration. It is the loss of the "gift of pain" that results in the development of what should be preventable foot lesions in many patients. As neuropathy is silent in up to 50% of patients, all diabetic patients should receive an annual screening by careful examination of the lower limbs for evidence of any sensory loss or peripheral vascular disease. Similarly, it must be remembered when treating neuropathic foot lesions that patients will willingly weight-bear on plantar ulcers: suitable offloading is therefore the first-line treatment for such lesions.