The notion that neuropathy is generally necessary to produce a diabetic foot ulcer has been well established. However, the methods of testing to identify loss of protective sensation along the spectrum of neuropathy have been quite variable and ill defined. In an attempt to provide a simple, inexpensive, and reliable means of testing for the absence of protective sensation, the Semmes-Weinstein monofilament wire system (SW) has been widely advocated as a screening tool. Several reports have discussed the potential clinical use of monofilaments, particularly the 10-g monofilament, in identifying patients at risk for foot ulceration.9,13- 15 Additionally, measurement of the vibration perception threshold (VPT) using a simple handheld tactor is another popular method for establishment of a threshold for protective sensation.10,16 Finally, some investigators have measured specific subjective symptoms and included them in the overall assessment of protective sensation.17 While all these studies support the notion that these instruments may be clinically useful, inconsistent testing methods, different sites of testing on the foot, and various recommendations for interpreting the data have contributed to confusion. Furthermore, many of these studies have reported sensitivity and specificity data with very small sample sizes and in some cases, no control group for comparison.9,14,18,19 The purpose of this study was to evaluate the sensitivity and specificity of 3 simple, commonly used sensory perception testing instruments to screen for risk of diabetic foot ulceration.