4.8.2 Pe­riph­er­al Neu­ropa­thy

De­creased pain sen­sa­tion and a high­er pain thresh­old in the ex­trem­i­ties re­sult in an in­creased risk of skin break­down, in­fec­tion, and Char­cot joint de­struc­tion with some forms of ex­er­cise. There­fore, a thor­ough as­sess­ment should be done to en­sure that neu­ropa­thy does not alter kines­thet­ic or pro­pri­o­cep­tive sen­sa­tion dur­ing phys­i­cal ac­tiv­i­ty, par­tic­u­lar­ly in those with more se­vere neu­ropa­thy. Stud­ies have shown that mod­er­ate-‍in­ten­si­ty walk­ing may not lead to an in­creased risk of foot ul­cers or reul­cer­a­tion in those with pe­riph­er­al neu­ropa­thy who use prop­er footwear (159). In ad­di­tion, 150 min/‍week of mod­er­ate ex­er­cise was re­port­ed to im­prove out­comes in pa­tients with predi­a­bet­ic neu­ropa­thy (160). All in­di­vid­u­als with pe­riph­er­al neu­ropa­thy should wear prop­er footwear and ex­am­ine their feet daily to de­tect le­sions early. Any­one with a foot in­jury or open sore should be re­strict­ed to non–weight-‍bear­ing ac­tiv­i­ties.