Patients may complain of neuropathic pain, numbness, or a tight, wooden leg, often worse at night or with standing. 58 Examination findings include decreased pain, touch, temperature, vibration, and proprioceptive sensation. In the leg, weakness usually begins in dorsiflexors before plantarflexors. 54 Atrophy may be visible directly or as muscular imbalance leading to hammertoes. Patients may lose the ability to walk on heels before tip-toe. 55 Ankle-jerk reflex may be diminished or absent, although this finding is common among elderly patients without DSP. 54 For diabetics, use of either a tuning fork to test vibratory sensation or a Semmes-Weinstein monofilament can accurately predict neuropathy on nerve conduction study; inability to walk on heels and abnormalities of deep tendon reflexes are less useful.