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:: Sensory Foot Examination

Sensory foot examination

Neuropathy can be detected using the 10g (5.07 semmes-weinstein) monofilament, tuning fork (128 Hz), and/or cotton wisp.

Semmes-Weinstein monofilament

  • Sensory examination should be done in a quiet and relaxed setting. First apply the monofilament on the patient's hands (or elbow, or forehead) so the patients know what to expect.

  • The patient must not be able to see if and where the examiner applies the filament. The three sites to be tested on both feet are indicated in figure 3.

  • Apply the monofilament perpendicular to the skin surface. (Figure 4).

  • Apply sufficient force to cause the filament to bend or buckle (figure 5)

  • The total duration of the approach, skin contact, and removal of the filament should be approximately 2 seconds.

  • Apply the filament along the perimeter of and not on an ulcer site, callus, scar or necrotic tissue. Do not allow the filament to slide across the skin or make repetitive contact at the test side.

  • Press the filament to the skin and ask the patient IF they feel the pressure applied (yes/no) and next WHERE they feel the pressure applied (left/right foot).

  • Repeat this application twice at the same site, but alternate this with at least one "sham" application, in which no filament is applied. (Total three questions per site).

  • Protective sensation is present at each site if the patients correctly answers two out of three. If two out of three answers are wrong, patient is considered to be at risk of ulceration.

  • Encourage the patients during testing.

Fig-3
 
Sites to be tested with the monofilaments
Fig-4
Fig-5
Application of the monofilaments
Fig-6

Tuning Fork

  • The sensory exam should be done in a quiet and relaxed setting. First apply the   tuning fork on the patient's wrists (or elbow, or clavicle) so the patient knows what to expect.

  • The patient must not be able to see if and where the examiner applies the tuning   fork. The tuning fork is applied on a bony part on the dorsal side of the distal phalanx   of the first toe.

  • It should be applied perpendicularly with a constant pressure. (See figure 6)

  • Repeat this application twice, but alternate this with at least one "sham" application,   in which the tuning fork is not vibrating.

  • If the patient correctly answers on at least two out of three tries, protective sensation is present and at risk for ulceration with two incorrect answers out of three.

  • If the patient is unable to sense the vibrations at the big toe, the test is repeated more proximally (malleolus, tibial tuberosity). Encourage the patient during testing.

Easy to use foot screening assessment sheet for clinical examination

The foot is at risk if any of the below are present
Deformity or bony prominences Yes/No
Skin intact Yes/No

Neuropathy

  • Monofilament detectable
  • Tuning fork detectable
  • Cotton wool detectable

 

Yes/No
Yes/No
Yes/No

Abnormal pressure, callus
Loss of joint mobility
Yes/No
Yes/No

Foot pulses

  • Posterior tibial artery felt
  • Dorsalis pedis artery felt

Discoloration on dependency

 

Yes/No
Yes/No

Yes/No

Any others

  • Previous ulcer
  • Amputation

 

Yes/No
Yes/No

Inappropriate footwear Yes/No
Actions to be taken
Action recommended Yes/No
Referral Yes/No

 

LATEST DEVELOPMENT IN THE RELIEF OF PAINFUL DIABETIC POLYNEUROPATHY

The use of pulsed galvanic stimulation of large areas of hands, legs and feet, using silver mesh stocking electrodes and the micro pulsed galvanic stimulator apparatus, has been tried in a large number of patients with very good results in obtaining relief (85 - 95%)

SILVER THERA STOCKING ELECTRODES (PRIZM MEDICAL Inc., USA.)

Potentially Limb Threatening Situation
Practical Guidelines on the Management and Prevention of diabetes
Foot Ulcer Treatment
Foot Care Tips



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