New publication in JAPMA offers practical recommendations to strengthen early detection, coordinate care and advance limb preservation worldwide.
Read the full open-access article in JAPMA.
Preventing an amputation begins long before a patient develops a limb-threatening wound. For people with diabetes, one of the most important opportunities is recognizing and managing peripheral neuropathy, the nerve damage that can cause pain, diminish protective sensation, and leave a foot injury unnoticed.
To help clinicians act on that opportunity, the American Limb Preservation Society (ALPS) convened an international, multidisciplinary group of experts to bring existing guidelines, newer evidence and international recommendations together in a practical publication: “Diabetic Peripheral Neuropathy: Implementing Guidelines into Practice.”
Published Oct. 9, 2026, in the Journal of the American Podiatric Medical Association (JAPMA), the open-access article focuses on translating evidence into everyday care.The effort advances ALPS’ mission to eliminate preventable amputations over the next generation. It also reflects a central principle of limb preservation: meaningful progress requires collaboration across specialties, institutions, and borders.
“Whether it is painful or painless, peripheral neuropathy is a debilitating complication of diabetes. ALPS assembled a team of interdisciplinary experts to summarize the major guidance documents and provide practical strategies on how to use best evidence in practice to reduce pain, keep people active, and avoid foot ulcers and amputations, comments Lee C. Rogers, DPM, FFPM RCPS(Glasg), Chief of Podiatry, University of Texas Health Science Center at San Antonio.
Bringing international expertise to a shared challenge
ALPS assembled eight internationally recognized experts whose collective work spans diabetic foot care, endocrinology, neuropathy research, neurosurgery and pain medicine:
- Lee C. Rogers and Robert G. Frykberg, UT Health San Antonio.
- Brian D. Lepow, Hope Clinic of Houston.
- David G. Armstrong, University of Southern California.
- Erika A. Petersen, University of Arkansas for Medical Sciences.
- Rodica Pop-Busui, Oregon Health & Science University.
- Solomon Tesfaye, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom.
- Shravani Durbhakula, Vanderbilt University.
Their collaboration brings multiple clinical perspectives to a condition that affects up to half of people with diabetes. Diabetic peripheral neuropathy can disrupt sleep, limit mobility and diminish quality of life. Loss of protective sensation can also increase vulnerability to foot ulcers and complications that threaten a limb.
“The publication of this consensus document in JAPMA reflects ALPS’ commitment to bridging the gap between clinical evidence and everyday patient care. By bringing together multidisciplinary experts, ALPS can translate established guidelines into practical, actionable clinical pathways that healthcare professionals can implement across specialties. Our goal is to move beyond publishing recommendations to putting evidence into practice, improving patient outcomes, and ultimately reducing preventable amputations,” comments Georgia Krehbiel, MBA CEO, American Limb Preservation Society (ALPS)
Moving from recommendations to routine care
Clinical guidelines already offer substantial direction on diabetic neuropathy. The challenge is making those recommendations a consistent part of clinical practice.
The ALPS-convened task force revisits that guidance, incorporates newer evidence and offers a systematic approach to implementation. The publication draws on recommendations from organizations including the American Diabetes Association, American Academy of Neurology, International Diabetes Federation and International Working Group on the Diabetic Foot, alongside other national and international guidance.
Its priorities include routine screening, comprehensive foot assessment, care matched to each patient’s risk, individualized pain management, patient education and timely specialist referral.
The article also addresses the practical work needed to sustain those priorities: defining staff responsibilities, improving documentation, establishing referral pathways, supporting follow-up and measuring performance. It emphasizes adapting these approaches to local resources, including settings with limited staffing or specialist access.
A framework with global relevance
ALPS’ international partnerships and educational programs create opportunities to share practical knowledge across health systems. This publication supports that work by providing a framework that clinicians can adapt to the communities they serve.
More consistent implementation could help care teams identify neuropathy earlier, recognize patients at greater risk of foot complications, address pain and functional limitations, and reduce gaps between screening and treatment. These are opportunities to improve care; the publication is an expert review and implementation framework, rather than a trial demonstrating the outcomes of the framework itself.
For ALPS, bringing this expert group together is another step toward connecting evidence, education and interdisciplinary care in service of limb preservation. The goal is to make effective prevention and coordinated treatment part of everyday practice—where they can make a difference for patients.
Read the full open-access article in JAPMA.