Estimated likelihood of distal symmetric polyneuropathy

Neuropathic symptoms	Diminished or absent ankle reflexes*	Diminished distal sensation	Distal muscle weakness or atrophy	Nerve conduction studies	Ordinal likelihood
Yes	Yes	Yes	Yes	Abnormal	4
No	Yes	Yes	Yes	Abnormal	4
Yes	Yes	Yes	No	Abnormal	4
Yes	Yes	No	No	Abnormal	4
Yes	No	Yes	No	Abnormal	4
No	Yes	No	Yes	Abnormal	3
Yes	No	No	No	Abnormal	3
No	No	No	No	Abnormal	2
No	Yes	No	No	Abnormal	2
Yes	Yes	Yes	No	Normal	2
Yes^¶	No	Yes^¶	No	Normal^¶	1
Yes^Δ	Yes^Δ	Yes^Δ	Yes^Δ	Normal^Δ	0

Neuropathic symptoms include numbness, altered sensation, or pain in the feet.

* Note that ankle reflexes may be diminished in normal people who are ≥65 years old.
¶ This phenotype is observed in small-fiber sensory polyneuropathy. Intraepithelial nerve fiber density determination by skin biopsy may be helpful to confirm the diagnosis.
Δ This phenotype is not a distal symmetric polyneuropathy when nerve conduction studies are normal.

Adapted with permission from: England JD, Gronseth GS, Franklin G, et al. Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2005; 64:199. Copyright © 2005 Lippincott Williams & Wilkins.

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Estimated likelihood of distal symmetric polyneuropathy