Painful and painless neuropathy often coexist, and a patient focused on burning pain may already have lost protective sensation. The 10 g monofilament at several sites on each foot, plus one other test such as vibration with a 128 Hz tuning fork, identifies the patient at risk of ulceration.
A patient with loss of protective sensation needs footwear advice, daily self-inspection and a review interval set by risk, whatever their pain score.
- Test with a 10 g monofilament and one other modality, such as a 128 Hz tuning fork.
- Examine both feet with shoes and socks off at every annual review.
- Record loss of protective sensation clearly; it changes footwear and follow-up advice.
- Ask patients with neuropathy to check their feet daily, using a mirror if needed.
Why it matters
Pain relief does not restore protective sensation, so ulcer risk must be assessed separately.
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