Once protective sensation is lost, the risk of foot ulcerations
increases sevenfold because of the increased vulnerability to
unrecognized trauma
14,15. While the so-called gold standard
for diagnosing peripheral neuropathy remains nerve conduction
studies, the most commonly used instrument clinically is the
10-g (5.07) nylon Semmes-Weinstein monofilament test
16-19. This
simple test can identify persons at an increased risk for foot
ulceration with a sensitivity of up to 91% and a specificity
of up to 86%
20-22. Vibration testing with a 128-Hz tuning fork
can also be used and may be an even more sensitive predictor
of early neuropathy
16. It is important to identify neuropathy
in all diabetic patients and particularly in those who have
sustained an ankle fracture.
