Diabetic peripheral neuropathy is usually discussed in relation to foot ulceration, balance, falls and loss of protective sensation.
But there may be another important consequence that receives far less attention: driving.
A recent article in The Conversation, based on newly published research, highlights how nerve damage affecting the feet may make it harder for some people with diabetes to accurately control the accelerator and brake pedals.
The issue is particularly relevant for prosthetists, orthotists, physiotherapists, podiatrists, occupational therapists and rehabilitation physicians because it demonstrates how sensory loss can affect everyday participation well beyond the clinic.
What Happens When You Cannot Feel Where Your Foot Is?
Most drivers rarely think consciously about the position of their right foot.
They move between the accelerator and brake largely through a combination of sensation, proprioception and learned motor control.
Proprioception is the body’s ability to recognise the position and movement of a joint without looking at it.
Diabetic peripheral neuropathy can interfere with this system.
As sensory nerves become damaged, a person may have reduced ability to feel pressure under the foot and poorer awareness of ankle and foot position.
That may make a seemingly simple action — lifting the foot from the accelerator and accurately placing it on the brake — more difficult.
The latest research examined 44 licensed drivers using a driving simulator, including 15 people with diabetic peripheral neuropathy. The researchers investigated whether the sensory and motor changes associated with neuropathy could contribute to errors when operating vehicle pedals.
Pedal Confusion and Unintended Acceleration
The 2026 study reported a particularly concerning finding.
Only participants with diabetic peripheral neuropathy demonstrated episodes in which they produced sudden unintended acceleration when braking was required.
The researchers described these events as pedal confusion or pedal misapplication and proposed that impaired sensation and proprioception associated with neuropathy may contribute directly to these errors.
In practical terms, the driver intends to brake but incorrectly positions the foot and presses the accelerator.
The issue is not necessarily lack of knowledge or attention.
It may begin with altered sensory feedback from the foot and ankle.
This creates a different perspective on diabetic neuropathy.
A foot that cannot reliably detect damaging plantar pressure may also be less able to provide the sensory information necessary for precise interaction with a vehicle pedal.
Earlier Research Already Identified Differences in Pedal Control
The latest findings build on previous research.
A 2019 driving-simulator study compared active drivers with diabetic peripheral neuropathy, people with diabetes but no neuropathy, and healthy controls.
Participants with neuropathy showed:
- reduced ankle plantar-flexor strength,
- slower generation of muscle force,
- poorer ankle proprioception,
- altered accelerator-pedal use, and
- longer periods of loss of vehicle control.
Interestingly, drivers with neuropathy tended to use the accelerator toward the extremes of its range — either barely depressing it or pressing it much further — while spending less time using the middle range of pedal movement.
Despite driving more slowly than healthy participants, they still experienced more loss-of-control events.
This suggests that simply compensating by reducing speed may not completely overcome the sensory-motor impairment.
Braking May Also Be Affected
Accelerator control is only one part of the problem.
Other research has investigated braking performance in people with type 2 diabetes and peripheral neuropathy.
A study involving simulated vehicle-pedestrian conflicts found that participants with more severe neuropathy had longer brake reaction times and shorter minimum distances from a potential collision than comparison groups.
Interestingly, pedal design appeared to influence performance.
The researchers tested different distances between accelerator and brake pedals and different brake-pedal widths.
When the lateral distance between accelerator and brake was reduced to 45 mm, the performance disadvantage associated with severe neuropathy was no longer observed in the same way.
This raises an important rehabilitation question:
Could vehicle adaptation compensate for some of the functional consequences of diabetic neuropathy?
This Is More Than a Foot Problem
For rehabilitation professionals, the research demonstrates why diabetic peripheral neuropathy should not be considered solely as a skin-protection issue.
Neuropathy can affect:
Sensation — the driver may have difficulty feeling exactly where the foot contacts the pedal.
Proprioception — awareness of ankle and foot position may be impaired.
Muscle strength — plantar-flexor weakness may make controlled pedal movement more difficult.
Fine motor control — smoothly grading accelerator pressure may become harder.
Reaction and transfer between pedals — moving accurately from accelerator to brake may require more time or conscious attention.
The functional consequences can therefore extend from walking and balance to one of the most important activities for personal independence: driving.
The Role of the Rehabilitation Team
This is where multidisciplinary rehabilitation becomes particularly important.
A person with diabetic neuropathy may still be physically capable of entering a vehicle and moving the ankle, but that does not necessarily mean pedal control remains unaffected.
Assessment may need to consider more than muscle power and joint range.
For selected patients, relevant factors could include:
- plantar sensation,
- ankle proprioception,
- reaction time,
- foot and ankle strength,
- pedal localisation,
- footwear,
- lower-limb coordination, and
- actual driving performance.
Occupational therapists specialising in driver rehabilitation may have an especially important role when there is concern about safe pedal operation.
Referral for a formal driving assessment may be more appropriate than attempting to judge driving fitness from standard clinic tests alone.
Could Training Help?
There is also some encouraging evidence.
In earlier simulator research, participants with diabetic peripheral neuropathy improved when they drove the same simulated route a second time.
The duration of their loss-of-control events fell significantly during the repeat drive.
That suggests some aspects of performance may be trainable.
It also raises the possibility of developing targeted interventions including:
- simulator-based practice,
- sensory-motor training,
- pedal adaptation,
- enhanced visual feedback, and
- vehicle modification.
Researchers have already explored technological approaches to helping drivers with peripheral neuropathy, including warning systems designed to identify potentially unsafe foot-pedal interaction.
Vehicle Design Could Become Part of Rehabilitation
The 2026 researchers proposed several possible strategies for drivers affected by neuropathy, including acceleration-limiting technology and improved illumination of the driver’s footwell.
More broadly, the research raises an interesting question for assistive technology.
Modern vehicles contain increasingly sophisticated sensors capable of detecting lane position, obstacles, driver attention and emergency braking conditions.
It may eventually be possible for vehicles to detect abnormal pedal application patterns as well.
For rehabilitation professionals, this is a reminder that assistive technology does not end with the orthosis, prosthesis or walking aid.
Sometimes the environment itself can be adapted.
Footwear Should Also Be Considered
There is another issue relevant to orthotists and podiatrists: footwear.
People at risk of diabetic foot ulceration may be prescribed therapeutic or accommodative footwear designed primarily to redistribute plantar pressure and protect vulnerable tissue.
That remains essential.
However, bulky footwear, altered sole thickness or reduced tactile feedback could potentially change how a person perceives and operates vehicle pedals.
This does not mean protective diabetic footwear is unsafe for driving.
Rather, it suggests that footwear should be considered as part of the individual’s overall functional assessment, especially when significant neuropathy is present.
The objective is not simply to protect the foot while walking.
It is to enable the person to participate safely in everyday activities.
An Important Question for the IMEA Region
Diabetes represents a major health challenge across the Middle East, India and Africa, making the consequences of diabetic peripheral neuropathy particularly relevant to the IMEA rehabilitation community.
As increasing numbers of people live longer with diabetes, clinicians will encounter more patients dealing with its long-term neurological and musculoskeletal complications.
Driving may rarely appear on a standard diabetic foot assessment form.
Perhaps it deserves more consideration.
A patient who reports increasing numbness in the feet should certainly be assessed for ulceration risk and protective footwear requirements.
But clinicians might also consider asking:
“Have you noticed any change in how well you can feel or control the accelerator and brake?”
That simple question could reveal an important functional problem that otherwise remains hidden.
Diabetic peripheral neuropathy is not merely a condition of the foot.
Its effects can extend into mobility, independence, employment and, potentially, road safety.
For rehabilitation professionals, understanding those broader consequences is an important part of treating the person rather than only the impairment.
- Original Article – The Conversation: How diabetes can affect your ability to control the pedals while driving
- 2026 Study – Pedal Confusion and Diabetic Peripheral Neuropathy: Transportation Research Interdisciplinary Perspectives
- Accelerator Pedal Control in Diabetic Peripheral Neuropathy: View the study on PubMed
- Full Text – Accelerator Pedal Control Study: Read via PubMed Central
- Pedal Layout and Braking in Diabetic Peripheral Neuropathy: View the study on PubMed
- Driving Safety and Diabetic Peripheral Neuropathy: Transportation Research study