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BACKGROUNDS. Early detection of patients who are at risk for the development of a foot ulcer is crucial in the prevention of diabetic gangrene. The pathophysiology of diabetic foot ulceration is complex and its most important etiopathogenetic factors are neuropathy and impaired arterial blood supply. Systematic screening is necessary to identify patients at risk. Evaluation of sensory function is the cornerstone of screening for neuropathy. According to international recommendations, more than one method should be used. The most commonly used methods are light touch sensation testing with the standardized 10 g Semmes-Weinstein monofilament and vibration sensation testing with a 128 Hz tuning fork. Tip Therm® is an instrument for the detection of impaired warm/cold sensation. The objective of the study was to investigate the association between different screening methods.
METHODS. Neuropathy screening with 10 g Semmes-Weinstein monofilament, 128 Hz tuning fork and Tip Therm® testing was performed in 725 diabetic patients (394 men and 331 women, average age 62.1 ± 12.9 years) without previous amputation. The association between the screening methods was tested with the Pearson chi-square test for fit of distribution. The relationship between age and sensory impairment was also evaluated using the independent samples t-test.
RESULTS. Ten gram Semmes-Weinstein monofilament testing revealed loss of protective sensation in 86 (11.9%) patients, loss of vibration sensation was detected in 192 (26.5%) patients and the inability to discriminate warm/cold in 337 (46.5%) patients. Statistically significant differences were demonstrated between the results of the screening methods (all p < 0.05), but there was also a statistically significant association between them (all p = 0.000). The patients with and without sensory impairment differed statistically significantly with respect to age.
CONCLUSIONS. Ten gram Semmes-Weinstein monofilament, 128 Hz tuning fork and Tip Therm® are suitable methods for screening for sensory impairment and their simultaneous use increases the likelihood of detection of sensory nerve damage. In the observed group, an inability to discriminate between warm and cold was more prevalent than problems with light touch or vibration sensation.