Aesthesiometry: quantification of cutaneous pressure sensation in diabetic peripheral neuropathy.

The Semmes-Weinstein pressure aesthesiometer, which measures cutaneous pressure sensation, was used for quantifying sensory loss in diabetic peripheral neuropathy. Eighty subjects comprising four groups were tested: nondiabetic controls (Group C); non-neuropathic, diabetic controls (Group DC); diabetic subjects with neuropathy and without a history of pedal ulcerations (Group DN); and, diabetic subjects with a history of or active pedal ulceration (Group DU). Cutaneous pressure sensation of 10 dorsal and plantar sites on the foot were tested, using a method of interval comparison modeled after the two-alternative forced choice algorithm. The sensitivity threshold level was defined as the lightest probe in which the subject accurately chose the correct interval in at least 2 out of 3 trials. The mean sensitivity threshold level for Group DC was not significantly increased (p greater than .05) compared to Group C. In contrast, patients with neuropathy (Group DN or DU) showed a significantly higher mean sensitivity threshold (p less than .001) than either Group C or DC. In addition, this technique demonstrated that patients in Group DU had a mean sensitivity threshold that was statistically higher (p less than .001) than Group DN, although both groups of patients had symptomatic neuropathy. This study provides a direct demonstration that decreased sensation of pressure occurs in the feet of diabetic patients with a history of ulceration. The best discrimination between groups is obtained by requiring that three of the six plantar forefoot sites have a sensitivity threshold level of greater than 5.07 log (0.1 mg) force as the risk discriminator level. Semmes-Weinstein aesthesiometry should now be tested in a prospective study to demonstrate its effectiveness in determining those patients at great risk of developing foot ulcers.

[1]  D. Sims,et al.  Plantar sensory threshold in the ulcerative foot. , 1986, Leprosy review.

[2]  M. Dhanendran,et al.  Vertical forces acting on the feet of diabetic patients with neuropathic ulceration , 1981, The British journal of surgery.

[3]  Barrett Jp,et al.  Neuropathy and diabetic pressure lesions. , 1973, The Orthopedic clinics of North America.

[4]  Closing the Gap: The Problem of Diabetes Mellitus in the United States , 1985, Diabetes Care.

[5]  I. Steiness.  Vibratory perception in diabetics; a biothesiometric study. , 2009, Acta medica Scandinavica.

[6]  R H Gelberman,et al.  Sensibility testing in patients with carpal tunnel syndrome. , 1984, The Journal of bone and joint surgery. American volume.

[7]  G. Pearsall,et al.  Von Frey's method of measuring pressure sensibility in the hand: an engineering analysis of the Weinstein-Semmes pressure aesthesiometer. , 1978, The Journal of hand surgery.

[8]  I A Stokes,et al.  The neuropathic ulcer and loads on the foot in diabetic patients. , 1975, Acta orthopaedica Scandinavica.

[9]  E. Weledji,et al.  The Diabetic Foot , 2015 .

[10]  J. Arezzo,et al.  Thermal Sensitivity Tester: Device for Quantitative Assessment of Thermal Sense in Diabetic Neuropathy , 1986, Diabetes.

[11]  C. I. Franks,et al.  Dynamic Foot Pressure and Other Studies as Diagnostic and Management Aids in Diabetic Neuropathy , 1983, Diabetes Care.

[12]  J. Moorhouse,et al.  Sensory perception thresholds in patients with juvenile diabetes and their close relatives. , 1972, The New England journal of medicine.

[13]  R. Sekuler,et al.  Sensitive, objective procedure for evaluating response to light touch , 1973, Neurology.

[14]  R W Heinrichs,et al.  Touch perception thresholds in blind diabetic subjects in relation to the reading of Braille type. , 1968, Diabetes.