The neurological exam recommended
is designed to identify LOPS rather than
early neuropathy. The clinical examination
to identify LOPS is simple and requires no
expensive equipment. Five simple clinical
tests (use of a 10-g monofilament, vibration
testing using a 128-Hz tuning fork,
tests of pinprick sensation, ankle reflex assessment,
and testing vibration perception
threshold with a biothesiometer),
each with evidence from well-conducted
prospective clinical cohort studies, are
considered useful in the diagnosis of
LOPS in the diabetic foot. Any of the five
tests listed above could be used by clinicians
to identify LOPS, although ideally
two of these should be regularly performed
during the screening examd
normally the 10-g monofilament and one
other test. One or more abnormal tests
would suggest LOPS, while at least two
normal tests (and no abnormal test) would
rule out LOPS. The last test listed, vibration
assessment using a biothesiometer or similar
instrument, is widely used in the U.S.;
however, identification of the patient with
LOPS can easily be carried out without this
or other expensive equipment.