Defining loss of protective sensation in the diabetic foot

Although the importance of distal symmetric sensorimotor polyneuropathy as a risk factor for diabetic foot ulceration has been known for decades, attempts to identify the elusive point that defines loss of protective sensation have been futile. This manuscript will review the epidemiology and pathogenesis of peripheral neuropathy, discuss commonly used screening tools, and review recently reported data that more sharply define loss of protective sensation on the long spectrum of neuropathy.