Reevaluating the Stocking Distribution Pattern in Diabetic Peripheral Neuropathy

Reevaluating the Stocking Distribution Pattern in Diabetic Peripheral Neuropathy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Reevaluating the Stocking Distribution Pattern in Diabetic Peripheral Neuropathy ANDREW RADER, Zoe Becher, Aaron Ruter This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7946600/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: This study evaluates the prevalence and spatial distribution of sensory loss in individuals with diabetes using standardized monofilament testing. Specifically, it examined the frequency of the classically described axonal length-dependent, symmetric, "stocking" pattern of sensory impairment and tested whether this presentation is universally observed in diabetic peripheral sensory neuropathy. Methods: Consecutive patients with an established diagnosis of diabetes were screened at a rural clinic. Each leg was assessed using a 10-gram monofilament applied to standardized quadrants of the foot while the patient was visually blinded to the stimulus location. Any sensory loss was recorded and categorized based on its symmetry and anatomical distribution. Additional variables collected included sex, age, diabetes type and duration, height, weight, body mass index, and most recent hemoglobin A1c. Results: Among 549 individuals (1,098 limbs), the prevalence of any sensory loss was 69.8%. Of those with sensory loss symmetric sensory loss was observed in 36.3% of individuals, while a stocking distribution pattern was present in only 15.9%. Statistical analysis showed that height, hemoglobin A1c, and body mass index were independently associated with stocking-pattern sensory loss, with height having the strongest effect size. Conclusions: Although sensory loss is common in individuals with diabetes, the classical stocking distribution pattern is less prevalent than traditionally portrayed. These findings suggest that the standard clinical model may overstate the universality of this presentation and support the need for a more individualized approach to neuropathy assessment. This calls into question the reliance on stocking-pattern descriptors in clinical screening and underscores the need for site-specific sensory evaluation in routine diabetic foot exams. Health sciences/Diseases Health sciences/Endocrinology Health sciences/Health care Health sciences/Medical research Biological sciences/Neuroscience Full Text Additional Declarations No competing interests reported. Table 1 and 2 are available in the Supplementary Files section. Supplementary Files Table1DSPNStudy.docx Table2DSPNStudy.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 12 May, 2026 Reviewers agreed at journal 30 Apr, 2026 Reviewers invited by journal 19 Feb, 2026 Editor invited by journal 28 Oct, 2025 Editor assigned by journal 27 Oct, 2025 Submission checks completed at journal 27 Oct, 2025 First submitted to journal 25 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7946600","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":595225547,"identity":"d4896123-5025-47f9-bad9-de17996aa3f3","order_by":0,"name":"ANDREW 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Neuropathy","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7946600/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7946600/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study evaluates the prevalence and spatial distribution of sensory loss in individuals with diabetes using standardized monofilament testing. Specifically, it examined the frequency of the classically described axonal length-dependent, symmetric, \"stocking\" pattern of sensory impairment and tested whether this presentation is universally observed in diabetic peripheral sensory neuropathy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsecutive patients with an established diagnosis of diabetes were screened at a rural clinic. Each leg was assessed using a 10-gram monofilament applied to standardized quadrants of the foot while the patient was visually blinded to the stimulus location. Any sensory loss was recorded and categorized based on its symmetry and anatomical distribution. Additional variables collected included sex, age, diabetes type and duration, height, weight, body mass index, and most recent hemoglobin A1c.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong 549 individuals (1,098 limbs), the prevalence of any sensory loss was 69.8%. Of those with sensory loss symmetric sensory loss was observed in 36.3% of individuals, while a stocking distribution pattern was present in only 15.9%. Statistical analysis showed that height, hemoglobin A1c, and body mass index were independently associated with stocking-pattern sensory loss, with height having the strongest effect size.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough sensory loss is common in individuals with diabetes, the classical stocking distribution pattern is less prevalent than traditionally portrayed. These findings suggest that the standard clinical model may overstate the universality of this presentation and support the need for a more individualized approach to neuropathy assessment. This calls into question the reliance on stocking-pattern descriptors in clinical screening and underscores the need for site-specific sensory evaluation in routine diabetic foot exams.\u003c/p\u003e","manuscriptTitle":"Reevaluating the Stocking Distribution Pattern in Diabetic Peripheral Neuropathy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-23 14:13:45","doi":"10.21203/rs.3.rs-7946600/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-12T06:57:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325468027102061723209352092815911678104","date":"2026-04-30T06:38:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-19T09:59:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-28T11:34:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-27T06:40:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-27T06:38:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-10-25T11:51:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b607ac42-6b07-47ad-8123-712979c1396d","owner":[],"postedDate":"February 23rd, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-12T06:57:12+00:00","index":103,"fulltext":""},{"type":"reviewerAgreed","content":"325468027102061723209352092815911678104","date":"2026-04-30T06:38:49+00:00","index":99,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":63337951,"name":"Health sciences/Diseases"},{"id":63337952,"name":"Health sciences/Endocrinology"},{"id":63337953,"name":"Health sciences/Health care"},{"id":63337954,"name":"Health sciences/Medical research"},{"id":63337955,"name":"Biological sciences/Neuroscience"}],"tags":[],"updatedAt":"2026-02-23T14:13:45+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-23 14:13:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7946600","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7946600","identity":"rs-7946600","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}