Screening patients at risk for diabetic foot ulceration

Loss of foot protective sensation (LOPS) due to peripheral sensory neuropathy is associated with and predictive of diabetic foot ulceration (DFU) and amputation . Thus, identification of LOPS in diabetic patients is of paramount importance to implement specific actions in order to prevent foot problems.

The Semmes-Weinstein filament (SWF) remains the most widely used instrument to screen for LOPS but determination of vibratory perception threshold (VPT) has also been advocated as a valuable means to identify diabetic patients at risk of ulceration. From a practical point of view, SWF has some advantages over VPT measurement as it is more rapid and easier to perform, is inexpensive and does not require special skills; on the other hand, SWF gives only a binary response and does not quantify the severity of neuropathy. Whatever the pros and cons of both tests, the lack of a reference screening method is a problem.

This study aimed to compare VPT and SWF results in non-selected diabetic patients and to assess agreement between the two tests. From our study, it is not possible to determine the most accurate test among VPT and SWF for prediction of DFU.

How to perform a monofilament test: