Screening for the High-risk Foot of Ulceration: Tests of Somatic and Autonomic Nerve Function

Abstract

Diabetic foot ulcers affect almost 5% of the patients with diabetes and carry a huge physical, emotional, and financial burden. Almost 80% of amputations in patients with diabetes are preceded by a foot ulcer. The need for simple screening methods for prevention of foot ulcers and amputations is indisputable. Simple tests such as monofilament, tuning fork, vibration perception threshold determination, ankle reflexes, and pinprick sensation alone or in combination have been studied prospectively and can be used for identification of patients at risk. Newer tests examining sudomotor dysfunction and skin dryness have been introduced in recent years. In cross-sectional studies sudomotor dysfunction assessed by either sympathetic skin response or NEUROPAD™ (Miro Verbandstoffe GmbH, Wiehl-Drabenderhöhe, Germany) testing has been consistently associated with foot ulceration. In addition, NEUROPAD™ testing is simple, reproducible, and widely available and has a high sensitivity for the diagnosis of clinical or subclinical diabetic polyneuropathy. Prospective studies are required to establish whether sudomotor dysfunction can predict foot ulcers and if simple methods assessing sudomotor dysfunction (eg, NEUROPAD™ testing) can be included in the screening tests for the prevention of this complication.

Relationship of Limited Joint Mobility and Foot Deformities with Neurological Examination in Patients with Diabetes

“…One of the major debilitating complications of Diabetes Mellitus (DM) is Diabetic Neuropathy (DN), which aff ects diff erent regions of the nervous system leading to several clinical manifestations [ 1 ] . Diabetic distal symmetric sensorimotor polyneuropathy is the most prevalent form of DN, and it has been associated with a high risk of foot ulceration on account of loss of sensitivity [ 2 ] . On the other hand, motor dysfunction leads to weakness of intrinsic foot muscles causing the development of deformities mainly localized in the forefoot [ 3 ] .…”

Bioimpedance phase angle analysis of foot skin in diabetic patients: An experimental case study

“…The reported prevalence of foot ulcers for a variety of population ranges from 2% up to 10% [1,2]. Simple tests such as monofilament, tuning fork, ankle reflexes, determination of a vibration perception threshold, and pinprick sensation alone or in combination have been studied and have shown to be useful tools for identification of patients at risk of diabetes foot disease [3,4]. Most of the available literature is focused on the median nerve neuropathy at the carpal tunnel level [5] or the tibia nerve neuropathy at the tarsal tunnel level [6], being the median and tibia nerves the relatively longest ones of all peripheral nerves.…”

Διάγνωση Της Περιφερικής Αγγειοπάθειας Σε Άτομα Με Σακχαρώδη Διαβήτη Τύπου 2

“…Η δύναµη που ασκείται µε τα 5.07 Semmes-Weinstein µονοϊνίδια είναι της τάξης των 10 γραµµαρίων. Ακόµα δεν υπάρχει οµοφωνία όσο αφορά τον αριθµό και την τοποθεσία των σηµείων στα οποία πρέπει να εξετάζεται το µονοϊνίδιο[44]. Η πλειοψηφία των µελετών υποδεικνύει ότι τρία είναι τα σηµεία που πρέπει να εκτιµηθούν σε κάθε κάτω άκρο µε το µονοϊνίδιο, και αυτά ο ασθενής δώσει σωστές απαντήσεις σε τουλάχιστον δύο από τα τρία εξεταζόµενα σηµεία σε κάθε άκρο[40].…”