The routine examination of peripheral sensitivity, which has always been a compulsory component of every neurological assessment, is indispensable in diabetology and general medicine – primarily with regard to the development and diagnosis of diabetic peripheral neuropathy.

From the multitude of neurological examination techniques, it is essential to select those that supply reliable results of practical relevance and which can be carried out easily and economically.

“The expenditure of apparatus and time must be in a sensible proportion to the expected practical test result” (Marco Mumenthaler).

Of all the 13 (!) known and established clinical examination techniques for testing sensitivity, the following three are proven to be reliable and practical:

TIP-THERM for testing temperature discrepancy (cold/warm)
10-g Monofilament for testing superficial sensitivity (touch)
128 Hz tuning fork for testing vibratory sense

Temperature discrimination and tactile sensitivity are of particular practical significance as they have a direct protective function in everyday life. Placed together under the term “protective sensitivity”, they are not only to be emphasized for their diagnostic relevance in detecting diabetic peripheral neuropathy, but also as an important protective function for persons affected with diabetes.

Regular checking of this protective sensitivity establishes a safeguard for the earliest affected fibres (poorly myelinated or non-myelinated A-Delta and A-Beta fibres) in diabetic peripheral neuropathy.

For the attending physician, this means:

- Establishing a diagnosis of diabetic peripheral neuropathy as early as possible.
- Enables the early implementation of therapy.

For patients, this means there are immediate practical benefits with a clear instruction of action:

with an intact protective sensitivity, the feet can be stressed or exercised the same as those of any healthy person. Activity and exercise are important factors of effective diabetes management and maintaining intact sensitivity of the feet allow the continuation of a person’s capability to undertake regular exercise and activity. If there is evidence of reduced protective sensitivity, one can assume a preclinical stage of a diabetic peripheral neuropathy exists. Once diagnosed, the rules of podology for diabetic peripheral neuropathy should be applied in order to halt or retard further progress of the neuropahty.

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