Along the pathway to foot ulceration there are many physical examination clues that can precede a diabetic foot ulceration. As part of the comprehensive preventive examination of the foot, a practitioner should be evaluating for neuropathy, deformity and trauma. This post will discuss the components of the comprehensive neurologic assessment as recommended by the Foot Care Interest Group of the American diabetes association. A link to the entire reviews is below.

Peripheral sensory neuropathy is the most common cause in the road to a diabetic foot ulceration. Identification of loss of protective sensation is a key physical examination finding that is easy and inexpensive to identify in daily clinical practice. The ADA task force has identified 5 clinical tests which can aid a clinician in the identification of loss of protective sensation. Ideally 2 tests should be used to identify lack of protective sensation, the 10gm monofilament and one other are  recommended.

5 clinical tests for identification of lack of protective sensation

10gm monofilament test

128-Hz Tuning fork

Pinprick sensation

Ankle reflexes

Vibration perception threshold testing

Early identification of the neurologically impaired foot is vital for prevention of ulcerations as well as management of existing diabetic foot ulcers. Preventive measures such as more frequent screening, accommodative footwear and risk factor modification may help prevent the march down the path to ulceration.

Over the next few weeks each of the individual tests above will become live links with comprehensive descriptions of each test, and a video tutorial.