Screening patients at risk for diabetic foot ulceration: a comparison between measurement of vibration perception threshold and 10-g monofilament test

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.

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

Journal of Diabetes Science and Technology ◽

10.1177/1932296818804552 ◽

2018 ◽

Vol 14 (1) ◽

pp. 16-21 ◽

Cited By ~ 2

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.

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Choosing a Practical Screening Instrument to Identify Patients at Risk for Diabetic Foot Ulceration

Archives of Internal Medicine ◽

10.1001/archinte.158.3.289 ◽

1998 ◽

Vol 158 (3) ◽

pp. 289 ◽

Cited By ~ 263

Author(s):

David G. Armstrong ◽

Lawrence A. Lavery ◽

Steven A. Vela ◽

Terri L. Quebedeaux ◽

John G. Fleischli

Keyword(s):

At Risk ◽

Diabetic Foot ◽

Screening Instrument ◽

Foot Ulceration ◽

Patients At Risk

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Study to assess neuropathy severity in patients with diabetic foot problems

International Surgery Journal ◽

10.18203/2349-2902.isj20204686 ◽

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.

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Vibration perception threshold measured by a bone vibrator of audiometer

Korean Journal of Occupational and Environmental Medicine ◽

10.35371/kjoem.1993.5.2.244 ◽

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

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Vibration Perception Threshold and Heart Rate Variability as methods to assess chemotherapy-induced neuropathy in women with breast cancer – a pilot study

Cancer Treatment and Research Communications ◽

10.1016/j.ctarc.2021.100426 ◽

2021 ◽

pp. 100426

Author(s):

Simone Diedrichsen Marstrand ◽

Kristian Buch-Larsen ◽

Michael Andersson ◽

Lars Thorbjørn Jensen ◽

Peter Schwarz

Keyword(s):

Breast Cancer ◽

Heart Rate ◽

Heart Rate Variability ◽

Pilot Study ◽

Perception Threshold ◽

Vibration Perception Threshold ◽

Vibration Perception

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Importance of Time Spent Standing for Those at Risk of Diabetic Foot Ulceration

Diabetes Care ◽

10.2337/dc10-1224 ◽

2010 ◽

Vol 33 (11) ◽

pp. 2448-2450 ◽

Cited By ~ 45

Author(s):

B. Najafi ◽

R. T. Crews ◽

J. S. Wrobel

Keyword(s):

At Risk ◽

Diabetic Foot ◽

Foot Ulceration

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Diagnostic accuracy of monofilament test to detect diabetic neuropathy

Journal of Advances in Internal Medicine ◽

10.3126/jaim.v10i1.37086 ◽

2021 ◽

Vol 10 (1) ◽

pp. 20-25

Author(s):

Sujan Shrestha ◽

Mamen Prasad Gorhaly ◽

Manil Ratna Bajracharya

Keyword(s):

Peripheral Neuropathy ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Diabetic Peripheral Neuropathy ◽

Perception Threshold ◽

Sensitivity Specificity ◽

Vibration Perception ◽

Monofilament Test

Background Diabetic peripheral neuropathy (DPN) is a significant independent risk factor for diabetic foot, and an effective screening instrument is required to diagnose DPN early to prevent future ulceration and amputation. This study aims to determine the diagnostic accuracy of monofilament test to detect diabetic peripheral neuropathy. Methods This cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital, Mahabouddha, Kathmandu from February 2016 to January 2017. A total of 96 diabetic patients attending inpatient and outpatient Department were selected. Diabetic peripheral neuropathy was assessed by measurement of loss of protective sensation (LOPS) by monofilament test and compared with vibration perception threshold by standard biothesiometer. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were calculated. Results The prevalence of diabetic peripheral neuropathy was 26%. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were found to be 92.0%, 95.8%, 88.5% and 97.1% respectively. There was strong association between LOPS by monofilament and vibration perception threshold by biothesiometer. Conclusion This study showed a strong diagnostic accuracy of monofilament test to detect DPN when compared with biothesiometer. As monofilament test is a cheap, easily available, and portable, it can be used in the periphery where biothesiometer is not available.

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