When Nerves and Arteries Collide: Shared Biology, Diagnostic Pitfalls, and Integrated Care for Neuropathy and Peripheral Artery Disease

Peripheral artery disease (PAD) and diabetic neuropathy frequently coexist, blunting symptom reporting, complicating diagnosis, and increasing limb threat. In classic PAD, ischemic pain reflects atherosclerotic obstruction severity due to intact nociception, while diabetes or advanced age-related neuropathy masks ischemia, enabling unrecognized tissue necrosis. Based on literature searches through November 2025 (validated via randomized trials, cohorts, and consensus statements), this review synthesizes their shared biology and diagnostic pitfalls, noting they share metabolic roots but differ clinically. PAD involves macrovascular flow limitation, while neuropathic feet develop ulcers from lost protective sensation. Effective therapy requires multimodal care; an integrated, multidisciplinary approach is needed to interrupt ischemia, denervation, ulceration, and amputation cycles.