A simple technique to assess pressure sensation is to use a nylon monofilament, which, when applied perpendicular to the foot, buckles at a given force of 10 g. If the patient does not detect the filament, then protective pain sensation is lost (12). Alternatively, vibration perception threshold can be measured using a neurothesiometer although this is more suitable for research purposes. A vibration threshold greater than 25 V is strongly predictive of foot ulceration (13). Recently, the vibration perception threshold has been shown to be more sensitive than the 10 g monofilament for the assessment of individuals at risk for foot ulcers (14).
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