We agree with Nagai et al.(1) that the Semmes-Weinstein 10-g monofilament detects severe rather than mild diabetic peripheral neuropathy. However, the choice of monofilament to be used in clinical practice is based on its intended purpose. In our work, we were keen to detect patients at high risk of ulceration, whereas Nagai et al. were seeking an instrument that would detect neuropathy at an earlier stage. Our rationale for selecting the 10-g monofilament was to detect very highrisk patients so that limited resources of diabetes education and podiatry could be used for those who are most at risk of neuropathic ulceration. Another point emphasized in our article (2) was that even for a monofilament of any given strength, sensitivity and specificity for the detection of neuropathy can be varied according to the number of sites and the criteria for abnormalities.

We fail to see from the data provided by Nagai et al.(1) any evidence to substantiate the claim that the 4-g monofilament is better than the 10-g monofilament. Furthermore, we do not see any justification for the claim that the “4-g monofilament is the easiest to apply when factors such as cost,ease of application, and portability are taken into account.”

Nagai Y, Sugiyama Y, Abe T, Nomura G: 4-g monofilament is clinically useful for the detection of diabetic peripheral neuropathy.
Diabetes Care
McGill M, Molyneaux L, Spencer R, Heng LF, Yue DK: Possible sources of discrepancies in the use of the Semmes-Weinstein monofilament: impact on prevalence of insensate foot and workload requirements.
Diabetes Care