Diabetic Peripheral Neuropathy: Why a Video Call Cannot Clear Your Feet

The important distinction: movement support is not a foot-risk examination

Diabetic peripheral neuropathy (DPN) can alter sensation, balance and walking. Reduced sensation can also make an injury harder to notice. The risk of a diabetes-related foot ulcer is not determined by neuropathy alone; circulation, prior ulcers or amputation, deformity, skin condition and footwear also matter. A person may have nerve damage without obvious symptoms, which is why the American Diabetes Association recommends screening at diagnosis of type 2 diabetes, five years after type 1 diagnosis, and at least annually thereafter, with a comprehensive foot evaluation at least yearly. [1]

A camera can show some visible features, but it cannot reliably test protective sensation with a 10-g monofilament, assess pulses or establish an individual’s ulcer-risk category. Remote physiotherapy must never be framed as “your feet look fine, so you are safe.” A video appointment is useful for discussion and movement coaching when appropriate—not foot clearance.

What the India numbers mean

A 2025 community cross-sectional study in central Kerala screened 526 adults with type 2 diabetes using the clinical portion of the Michigan Neuropathy Screening Instrument. It reported 34.2% screen-positive peripheral neuropathy (95% confidence interval 30.2–38.4). This is a result from one municipality, one age and disease-duration group, and one screening definition. It is not an India-wide prevalence estimate, and screening positivity is not identical to a complete diagnostic work-up. [3]

What good assessment and prevention involve

Guidelines describe a clinical examination that may include sensory testing, circulation and pulses, skin and deformity review, prior ulcer history, and footwear. IWGDF identifies the 10-g monofilament as a key tool for loss of protective sensation, with other tests used according to clinical context. Risk level changes the follow-up and prevention plan. [1,2]

People with diabetes should check their feet regularly and seek professional advice promptly for a new blister, cut, sore, redness, swelling, discharge, or an area that is warmer than the other foot—especially if sensation is reduced. Do not wait for pain: neuropathy may blunt it. This article is not an emergency triage checklist; when a foot problem is rapidly worsening or you feel acutely unwell, use local urgent medical services. [2]

Where physiotherapy can fit

After medical and foot-risk needs have been addressed, a physiotherapist may help discuss walking confidence, balance, strength, safe daily activity and the home environment. A 2025 review in older adults with DPN found improvements in some balance measures across selected exercise types. The results do not prove that exercise prevents falls for every person, nor do they establish a universally safe home program. Foot status, sensation, vision, cardiovascular health, medications, footwear and fall history can change what is appropriate. [4]

Online discussion can review goals, symptoms, recent foot-care advice and whether in-person assessment is needed. The therapist may observe a simple movement only if the person’s safety and environment allow. It cannot replace a clinical foot examination. Home physiotherapy in India may help assess real-world walking and transfers, but it does not replace a podiatry/diabetes foot-care review or medical assessment. Goswami Rehab’s in-person home physiotherapy is India-only; service availability and suitability must be confirmed.

Questions to take to your care team

**Public video reference:** Indian Health Service, “Diabetes Foot Care” training resource, including a demonstration of a clinical foot examination. It is clinician education, not a self-exam or remote clearance tool: https://www.ihs.gov/diabetes/training/diabetes-foot-care

• When was my last diabetes foot examination, and what was my risk category?
• Do I need a sensory test, circulation check, footwear review or foot-care referral?
• What activity is appropriate given my current foot status, balance and other health conditions?
• If I notice a skin change, who should I contact and how quickly?