Without protective sensation, patients with neuropathy are at a heightened risk of unrecognized injury and are unlikely to mention their deformities to medical staff. Consequently, skin deterioration may unknowingly progress to ulceration that requires extensive medical intervention or amputation.

 

Neuropathic LOPS is easily detectable, yet it is linked to at least 75% of all nontraumatic diabetic amputations. Adiminished vibratory perception threshold (VPT) is one of the earliest indicators of neuropathic LOPS and is the best predictor of long-term lower extremity complications. However, VPT devices are expensive and time-consuming to operate, and they require training to ensure proper use. The Neuro monofilament is a well-documented alternative to VPT for predicting ulcer risk and has long been advocated as an essential component of a thorough foot exam. The 128 Hz tuning fork is another regularly used alternative. However, physicians would need to purchase one of these devices and receive training on how to use it, and, in the case of the monofilament, to regularly stock replacements to maintain accurate results.