Jo Panuwat D/ShutterstockPicture a driver approaching a sharp bend on a country road. As the car turns, they move their foot to slow down. But instead of pressing the brake, they hit the accelerator. The car surges forward.For some drivers with diabetes-related nerve damage in their feet, a situation like this may begin with something most of us rarely think about: the ability to sense where our foot is without looking at it.In our latest study, my colleagues and I examined 44 licensed drivers using a driving simulator. Fifteen had diabetic peripheral neuropathy – nerve damage caused by diabetes that affects the feet. The remaining drivers did not have neuropathy.When our drivers encountered demanding sections of the simulated route, including sharp bends, only people with neuropathy made a particular kind of mistake: pressing the accelerator when they needed to brake. None of the drivers without nerve damage made this pedal error.These findings provide new evidence that the nerve damage associated with diabetes can contribute to pedal confusion while driving.Diabetic peripheral neuropathy is one of the most common long-term complications of diabetes, eventually affecting around half of people with the condition. It damages nerves outside the brain and spinal cord, particularly those reaching the feet and lower legs.People may experience numbness, tingling or pain. As the condition becomes more severe, they can lose sensitivity to pressure and other sensations in their feet. Importantly, up to half of those with diabetic peripheral neuropathy may have no obvious symptoms, which means some may be unaware that nerve damage has developed. The new findings build on our earlier research which found that drivers with diabetic peripheral neuropathy used the accelerator differently from other drivers.Drivers without neuropathy tended to use the pedal progressively across its range. Those with nerve damage spent more time using either very low or very high accelerator positions, with less use of the middle range.They also had impaired ankle proprioception. Proprioception is the body’s internal sense of where its different parts are. It allows you, for example, to know roughly where your foot is without looking down at it.In another driving-simulator study, we found differences in the way drivers with neuropathy coordinated their eye movements and steering. When this coordination improved as they drove the route for a second time, they also spent less time losing control of the car.Together, these findings may help explain what is happening during pedal errors.Nerve damageWhen the nerves carrying information from the foot and ankle are damaged, the brain receives less reliable information about the foot’s position and movement. During a rapid manoeuvre, that could make it harder for someone to be certain which pedal their foot is touching.In our latest study, several participants with neuropathy looked down towards their feet while driving, apparently using vision to confirm their foot position. Drivers without neuropathy did not do this.This has implications beyond the laboratory because diabetic nerve damage is common and can develop without obvious symptoms.The prevalence of this condition may be particularly important among people who drive for work. A 2025 Diabetes Safety Organisation report, produced with transport and road-safety organisations, estimated that one in six commercial drivers has diabetes.The report cited a 2024 survey of 448 employees at 12 Road Haulage Association member companies, which estimated that as many as two in five employees in the road transport sector may have had the condition.UK driving rules already recognise that peripheral neuropathy can affect driving. DVLA guidance says drivers must report peripheral neuropathy, while its medical guidance on diabetes acknowledges that neuropathy affecting limb function may require changes such as vehicle adaptations.But current guidance does not include any routine driving assessment of the potential loss of foot and ankle position sense, as highlighted by our research.People with diabetes should already receive regular foot examinations. The National Institute for Health and Care Excellence (Nice) recommends checking for loss of sensation as part of these assessments. One possibility would be for signs of neuropathy detected during routine care to prompt questions about driving and, where appropriate, further assessment.Reducing the consequences of pedal errorsOur research also points towards possible ways of reducing the consequences of pedal errors.In our earlier research, people with neuropathy spent less time losing control of the car when they drove the same simulator route for a second time, suggesting that practice may help drivers adapt.Researchers could now investigate interventions such as acceleration limiters, which restrict how strongly a vehicle accelerates when the pedal is pressed, and improved footwell lighting for drivers who use vision to check the position of their feet.Another possibility is using a manual rather than an automatic car. Because the gear selected in a manual vehicle limits how the car responds to the accelerator, this could potentially reduce the severity of unintended acceleration if a driver presses the wrong pedal. But this, like the other proposed measures, needs to be tested properly before it can be recommended as a safety intervention.The next step is to connect what we already know about diabetic foot sensation with the demands of driving.If nerve damage can make it harder for someone to know which pedal their foot is on, identifying that problem before a dangerous pedal error occurs could help protect the driver, and everyone else sharing the road with them.Maaike Esselaar receives funding from Diabetes UK. Dilwyn Marple-Horvat receives funding from Diabetes UK.