Neurologic Evaluation Peripheral sensory neuropathy is the major risk factor for diabetic foot ulceration (24, 26, 27, 46, 50). The patient history and physical examination utilizing the SemmesWeinstein monofilament (10-g) wire are sufficient to identify individuals at risk for ulceration (26, 232-235). Vibration perception threshold assessment with the biothesiometer is also useful in identifying patients at high risk for ulceration (44, 57, 236). More sophisticated studies such as nerve conduction studies are rarely necessary to diagnose peripheral sensory neuropathy. Patients with neuropathic ulcerations usually have such profound sensory neuropathy that these studies add little to their clinical management.
