Combined Abnormality in the Acetylcholine Sweatspot Test and Vibration Perception Threshold Confers High Risk of Diabetic Foot Ulceration

1990 ◽  
Vol 78 (s22) ◽  
pp. 39P-39P
Author(s):  
REJ Ryder ◽  
KT Moriarty ◽  
CA Hardisty
Keyword(s):  
High Risk ◽  
Diabetic Foot ◽  
Perception Threshold ◽  
Foot Ulceration ◽  
Vibration Perception Threshold ◽  
Vibration Perception

scholarly journals Predicting the risk of future diabetic foot ulcer occurrence: a prospective cohort study of patients with diabetes in Tanzania

2020 ◽  
Vol 8 (1) ◽  
pp. e001122 ◽  
Author(s):  
Roozbeh Naemi ◽  
Nachiappan Chockalingam ◽  
Janet K Lutale ◽  
Zulfiqarali G Abbas
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Temperature Tolerance ◽  
Dry Skin ◽  
Perception Threshold ◽  
Foot Ulceration ◽  
Temperature Sensation ◽  
Patients With Diabetes ◽  
Vibration Perception

ObjectivesThe aim of this study was to identify the parameters that predict the risk of future foot ulcer occurrence in patients with diabetes.Research design and methods1810 (male (M)/female (F): 1012/798) patients, with no foot ulcer at baseline, participated in this study. Data from a set of 28 parameters were collected at baseline. During follow-up, 123 (M/F: 68/55) patients ulcerated. Survival analyses together with logistic regression were used to identify the parameters that could predict the risk of future diabetic foot ulcer occurrence.ResultsA number of parameters (HR (95% CI)) including neuropathy (2.525 (1.680 to 3.795)); history of ulceration (2.796 (1.029 to 7.598)); smoking history (1.686 (1.097 to 2.592)); presence of callus (1.474 (0.999 to 2.174)); nail ingrowth (5.653 (2.078 to 15.379)); foot swelling (3.345 (1.799 to 6.218)); dry skin (1.926 (1.273 to 2.914)); limited ankle (1.662 (1.365 to 2.022)) and metatarsophalangeal (MTP) joint (2.745 (1.853 to 4.067)) ranges of motion; and decreased (3.141 (2.102 to 4.693)), highly decreased (5.263 (1.266 to 21.878)), and absent (9.671 (5.179 to 18.059)) sensation to touch; age (1.026 (1.010 to 1.042)); vibration perception threshold (1.079 (1.060 to 1.099)); duration of diabetes (1.000 (1.000 to 1.000)); and plantar pressure at the first metatarsal head (1.003 (1.001 to 1.005)), temperature sensation (1.019 (1.004 to 1.035)) and temperature tolerance (1.523 (1.337 to 1.734)) thresholds to hot stimuli and blood sugar level (1.027 (1.006 to 1.048)) were all significantly associated with increased risk of ulceration. However, plantar pressure underneath the fifth toe (0.990 (0.983 to 0.998)) and temperature sensation (0.755 (0.688 to 0.829)) and temperature tolerance (0.668 (0.592 to 0.0754)) thresholds to cold stimuli showed to significantly decrease the risk of future ulcer occurrence. Multivariate survival model indicated that nail ingrowth (4.42 (1.38 to 14.07)); vibration perception threshold (1.07 (1.04 to 1.09)); dry skin status (4.48 (1.80 to 11.14)); and temperature tolerance threshold to warm stimuli (1.001 (1.000 to 1.002)) were significant predictors of foot ulceration risk in the final model. The mean time to ulceration was significantly (p<0.05) shorter for patients with: dry skin (χ2=11.015), nail ingrowth (χ2=14.688), neuropathy (χ2=21.284), or foot swelling (χ2=16.428).ConclusionNail ingrowth and dry skin were found to be strong indicators of vulnerability of patients to diabetic foot ulceration. Results highlight that assessments of neuropathy in relation to both small and larger fiber impairment need to be considered for predicting the risk of diabetic foot ulceration.

scholarly journals Mechanical Noise Improves the Vibration Perception Threshold of the Foot in People With Diabetic Neuropathy

2018 ◽  
Vol 14 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Jennefer B. J. Zwaferink ◽  
Juha M. Hijmans ◽  
Claudia M. Schrijver ◽  
Laura K. Schrijver ◽  
Klaas Postema ◽  
...  
Keyword(s):  
Diabetic Neuropathy ◽  
Metatarsophalangeal Joint ◽  
Piezoelectric Actuators ◽  
Dorsal Side ◽  
Double Blind ◽  
Perception Threshold ◽  
Foot Ulceration ◽  
Vibration Perception Threshold ◽  
Mechanical Noise ◽  
Vibration Perception

Background: Mechanical noise may improve somatosensation at the dorsal side of the foot, but the effect at the plantar side of the foot, the side most at risk for foot ulceration, is unknown. Moreover, techniques used in research so far have several problems that limit applicability in daily practice. Piezoelectric actuators may provide mechanical noise with better clinical applicability. We assessed the effects of piezoelectric actuators generating mechanical noise on the vibration perception threshold (VPT) at the plantar side of the foot in people with diabetic neuropathy. Methods: Double-blind within-subjects design in a controlled laboratory setting including participants with diabetic neuropathy (N = 40; 18 male; mean age 69.6 years; mean duration of diabetes 14.1 years; mean BMI 30.5). VPT was measured at three plantar foot locations with and without mechanical noise applied via piezoelectric actuators. Results: Mechanical noise improved VPT at metatarsophalangeal joint (MTP) 1 (left 39.3V vs 43.5V; right 39.0 vs 42.6 V), MTP5 (left 37.5V vs 41.7V; right 34.5V vs 40.8V) and the heel (left 40.0V vs 44.0V; right 39.3V vs 41.0V), all P < .001. Conclusions: Mechanical noise improves VPT at the plantar side of the foot in people with diabetic neuropathy. This is an important step for further development of insoles using mechanical noise that may have the potential to improve VPT and decrease the risk of foot ulceration.

scholarly journals Study to assess neuropathy severity in patients with diabetic foot problems

2020 ◽  
Vol 7 (11) ◽  
pp. 3762
Author(s):  
Someshwara Rao Pallela Narayana
Keyword(s):  
Diabetic Foot ◽  
Sampling Technique ◽  
Foot Care ◽  
Perception Threshold ◽  
Vibration Perception Threshold ◽  
Charcot Neuroarthropathy ◽  
Painful Sensation ◽  
Foot Problems ◽  
Vibration Perception

Background: Diabetic neuropathy is the most common complication of diabetes affecting 50% of the patients with type 1 and type 2 diabetes. Its late sequelae which include foot ulceration, charcot neuroarthropathy and occasionally amputation, should in many cases be preventable. Biothesiometry is a device which can measure the vibration perception threshold and guide the treatment as well as prevent further foot problems in such patients.Methods: In this study we included 65 patients with diabetic foot symptoms by random sampling technique between the age group of 40-75 years. All these patients were subjected to biothesiometer testing. The response was measured as vibration perception threshold (VPT). The variation of VPT in different conditions was established.Results: Among 65 patients, 40(61%) patients had painful sensation, VPT ranging from 16 V to 25 V, 6 (0.09%) patients had callus, dry foot or pigmentation with VPT 25-35 V, 12 (18.4%) patients had callus ulcer with VPT 36-45 V, 3 (0.046%) patients had both ulcer and skin changes with VPT 45-50 V and 4 (0.06%) patients presented with deformity and VPT 50 V.Conclusions: The study concluded that risk of ulceration is high with increased VPT. Hence, early detection of raised VPT would help the clinicians not only to guide the patients about the high risk of ulceration but it as well will help in educating the patient and emphasizing the need for proper glycemic control, proper footwear and foot care.

Vibration perception threshold measured by a bone vibrator of audiometer

1993 ◽  
Vol 5 (2) ◽  
pp. 244
Author(s):  
Jong Young Lee ◽  
Dong Hoon Shin ◽  
Seung Hoon Lee ◽  
Moo Sik Lee ◽  
Suk Kwan Suh ◽  
...  
Keyword(s):  
Perception Threshold ◽  
Vibration Perception Threshold ◽  
Vibration Perception

Relationship Between Glycated Hemoglobin and Vibration Perception Threshold in Diabetic Peripheral Neuropathy

2019 ◽  
Vol 19 (2) ◽  
pp. 120-124 ◽  
Author(s):  
Arun G. Maiya ◽  
Anche Parameshwar ◽  
Manjunath Hande ◽  
Vinayak Nandalike
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Glycated Hemoglobin ◽  
Pearson Correlation ◽  
Regression Result ◽  
Perception Threshold ◽  
Cross Sectional ◽  
Vibration Perception Threshold ◽  
The Relationship ◽  
Vibration Perception

Foot ulcers, infections, and deformity are some of the major sources of mortality and morbidity among the diabetic population. The relationship between glycated hemoglobin (HbA1c) and diabetic peripheral neuropathy (DPN) has been well established. There is a dearth of literature on the relationship between vibration perception threshold (VPT) and HbA1c values. So, the objective of the study was to determine the strength of linear relationship between HbA1c levels and vibration perception threshold in DPN. This cross-sectional study was conducted at Kasturba Hospital, Manipal, and diabetic foot screening camps held at various parts of Udupi district. Ethical approval was obtained from the Institutional Ethics Committee, Kasturba Hospital, Manipal (IEC:281/2017). A total of 534 participants ranging from 30 to 70 years of age and were diagnosed with type 2 diabetes mellitus on medications were included in the study. Neuropathy assessment consisting of monofilament and vibration perception threshold was done using Neurotouch beta version (Yostra Labs, Bengaluru, India). HbA1c measurement was done using turbidimetric inhibition immunoassay technique (Roche Diagnostics, Mannheim, Germany). Pearson correlation coefficient showed a moderate to good correlation between HbA1c and VPT ( r = .0.753, P < .001). Linear regression result has shown a significant relationship of VPT with HbA1c (4.033 [95% confidence interval = 3.67-4.39]). The present study has concluded that there is strong relationship between HbA1c values and VPT and could be a predictor for complications in the foot following DPN.

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