Painful diabetic polyneuropathy is one of the most common disabling problems worldwide. We aimed to determine if a perineural injection of hypertonic saline compared with foot acupoints decreased the neuropathic pain score in patients with diabetes. Patients were assigned to receive either perineural or acupoints injection of hypertonic saline 5% in their feet for three weekly sessions. Douleur Neuropathique 4 (DN4) questionnaire for neuropathic pain was assessed. Both groups observed a significant reduction of the DN4 score throughout 8 weeks of follow-up. Both perineural and acupoints hypertonic saline injections of the foot could improve neuropathic pain in patients with diabetes.