By Prof. Dr. Rao Suhail Yasin Khan

Consultant Neurologist, Advanced International Hospital

When a patient comes into my clinic complaining about burning, tingling, or numbness in their feet, one of the first things I consider is whether we’re dealing with Diabetic Neuropathy (DN) or Peripheral Artery Disease (PAD). Both conditions are common, especially in diabetics, and yet dangerously underdiagnosed. Left untreated, they can silently destroy quality of life, lead to ulcers, infections, and even amputations.

So let’s talk about it—in plain language—because understanding these conditions is the first step toward preventing their consequences.

What Is Diabetic Neuropathy?

Diabetic Neuropathy is a nerve-damaging complication of diabetes. When blood sugar levels remain elevated over time, they begin to damage the nerves, especially those farthest from the brain—typically in the feet and legs.

Symptoms may include:

• Numbness or loss of sensation in feet/toes
• Burning or tingling sensations
• Shooting pains or cramps
• Increased sensitivity to touch
• Muscle weakness in the legs

What Is Peripheral Artery Disease?

Peripheral Artery Disease, on the other hand, is a circulatory problem. In PAD, the arteries supplying blood to the legs and feet become narrowed or blocked, usually due to fatty deposits or atherosclerosis.

Key symptoms include:

• Cramping or pain in the legs during walking (claudication)
• Coldness in one foot or leg
• Weak or absent pulses in the foot
• Wounds on the feet or toes that heal poorly
• Shiny or discolored skin on the legs

Unlike DN, PAD is not about nerve damage—it’s about blood flow. If blood isn’t reaching your foot, it won’t heal well, making even minor wounds turn dangerous.

So, What’s the Difference?

While both conditions affect the lower limbs, their root causes and treatments differ:

Feature	Diabetic Neuropathy (DN)	Peripheral Artery Disease (PAD)
Cause	High blood sugar → nerve damage	Atherosclerosis → reduced blood flow
Main Symptom	Numbness, burning, tingling	Cramping pain, poor healing
Area Affected	Nerves in feet/legs	Arteries in feet/legs
Risk in Diabetes	Very high	Also high
Treatment Focus	Nerve protection, glucose control	Improve circulation, reduce blockages

And here’s the kicker—some patients have both conditions, which multiplies their risk for foot ulcers, infections, and amputations.

How Do We Diagnose These?

• Clinical Examination – checking for pulse, temperature differences, or loss of sensation.
• Monofilament Testing – simple tool to check for neuropathy.
• Doppler Ultrasound or ABI Test – to assess blood flow in the limbs.
• Blood Sugar and Lipid Levels – for diabetes and cholesterol control.

We believe in early detection, because by the time wounds form, the clock starts ticking.

When Should You See a Doctor?

Don’t wait until your foot is swollen, discolored, or wounded. See a specialist if you notice any of these:

• Persistent numbness, tingling, or pain in your feet
• Cramping or fatigue while walking short distances
• Slow-healing sores or ulcers
• Changes in the color or temperature of your feet

Prevention: A Team Effort

My Advice to :

1. Control your blood sugar – this is the single most important step.
2. Quit smoking – smoking worsens PAD drastically.
3. Inspect your feet daily – use a mirror to check the sole.
4. Wear protective shoes – even at home.
5. Exercise regularly – walking helps improve circulation.
6. Follow up with your doctor – even if you feel fine.

Treatment Options

Our multidisciplinary approach includes:

• Medical therapy: for sugar control, pain relief, and blood flow improvement.
• Wound care: if ulcers or infections develop.
• Vascular interventions: like angioplasty for PAD.
• Nerve pain management: medications and physiotherapy.
• Patient education: foot care counseling and lifestyle modification.

Take away message

Diabetic Neuropathy and Peripheral Artery Disease are not just foot problems—they are life-altering complications that demand attention.

If you or your loved ones are diabetic and experiencing foot discomfort, don’t chalk it up to “age” or “tiredness.” It could be your body’s silent cry for help.

We offer much better treatment here at Advanced International Hospital, Islamabad. A quick foot check could save a limb—and a life.

Prof Dr.Rao Suhail Yasin Khan

Consultant Neurologist

🌐 www.aih.com.pk