Table 3

Clinical assessment in diabetic symmetric distal polyneuropathy (DSDP)

  • Look for any deformity, callus or foot ulcer, infection or fissure

  • Absent ankle reflexes (mandatory)

  • Test all sensory modalities starting at the toes and fingertips (in many diabetic screening clinics, vibration sensation and neurofilament sensitivity are the only modalities tested and this seems to be an effective part of a neuropathy screen)

  • Weakness of small foot muscles (extensor hallucis longus and extensor digitorum brevis)

  • Check resting pulse and blood pressure lying and standing

  • Check peripheral pulses

  • Look for retinopathy

  • Check urine for protein