Continuing Education: Ce Feature ArticleDiabetic Neuropathy: Pathophysiology and Prevention of Foot UlcersZangaro, George A. M.S.N., R.N.; Hull, Margaret M. Ph.D., R.N.Author Information GEORGE A. ZANGARO is a clinical nurse specialist and a Lieutenant in the United States Navy, currently stationed at Roosevelt Roads, Puerto Rico. He holds a master of science degree in Medical Surgical Nursing from the University of Maryland, School of Nursing, Baltimore, Maryland. This article was written during Lt. Zangaro's master's program. MARGARET M. HULL is an assistant professor at the University of Maryland, School of Nursing, Department of Adult Health, where she teaches nursing research in the undergraduate program and medical surgical and oncology nursing in the advanced practice graduate programs. She received her doctorate from the University of Rochester, Rochester, New York. NOTE: The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government. Clinical Nurse Specialist: March 1999 - Volume 13 - Issue 2 - p 57-65 Buy Abstract Diabetic neuropathy, which affects 60% to 70% of those with diabetes mellitus, is one of the most troubling complications for persons with diabetes, often leading to foot ulcers and potentially to lower limb amputations, both of which are preventable. The physiologic, structural, and functional changes associated with diabetic neuropathy and foot ulcers are discussed. Advanced practice nurses are in a unique position to implement strategies for the prevention of serious and debilitating complications from diabetic neuropathy, including foot assessment, education, and specialist referrals. Research evidence is given to support the use of the Semmes-Weinstein monofilaments to evaluate decreased plantar sensation, a common precursor to ulceration. Ongoing patient and family education can emphasize the importance of preventive self-care measures. Referrals for specialist care and therapeutic footwear can be made by advanced practice nurses. If begun early, these interventions can prevent foot ulcers from diabetic neuropathy, thereby improving the quality of life and reducing healthcare costs for this chronic disease. © 1999 Lippincott Williams & Wilkins, Inc.