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Background: Diabetic foot ulceration (DFU) affects only a subgroup of patients with diabetic neuropathy, that is, those with pain-insensitivity due to end-stage sensory failure. Pain perception failure develops insidiously and remains asymptomatic until first DFU. As loss of pain perception is clinically significant, timely detection is mandatory., Objectives: A novel suprathreshold pinprick pain stimulus of 512 mN force made from optical glass-fiber was explored in a prospective cross-sectional diagnostic accuracy study to detect DFU-related end-stage sensory failure., Methods: A total of 116 participants were studied (25 healthy people, 22 patients with diabetes without relevant complications, 19 patients with previous painful foot or leg injuries, and 50 patients with previous or active painless DFU [reference standard]). Palmar and plantar surfaces were stimulated in a standardized fashion. At the feet, the second and third toe skinfolds and the middle of the plantar arch were stimulated. Participants scored stimulated pricking discomfort or pain intensity 0 to 10 on a numerical rating scale., Results: At hands, intensity was rated on average 5 (1-10) [median (range)] by 114/116 participants. Per foot, participants without DFU scored 5 (1-10), while those with DFU scored 0 (0-3) ( P < .0001). At plantar toe skinfolds, the absence of pinprick pain perception detected DFU-associated sensory failure with an accuracy of 99.5% (sensitivity 99.5%, specificity 99.4%, positive likelihood ratio 248, and negative likelihood ratio 0.005)., Conclusion: In this pilot study, nociceptive stimulation of a plantar toe skinfold with a 512 mN optical glass-fiber pinprick accurately identified DFU-associated end-stage sensory failure.

The present study evaluated the properties of nails, frequency of ingrown nails in patients with type 2 diabetes mellitus (DM), risk factors for developing ingrown nails, and effect of diabetic polyneuropathy and vasculopathy on the development and outcome of ingrown nails. Our 6-month epidemiologic prospective study included 300 patients with type 2 DM attending a DM outpatient clinic for routine examinations. The general characteristics and foot changes of the study population were investigated. Diabetic polyneuropathy and vasculopathy were evaluated using a biothesiometer, monofilament tests, and arterial Doppler ultrasonography. The frequency of ingrown nails was 13.6%. Multivariate analysis with logistic regression showed that body mass index (odds ratio [OR] 1.077, 95% confidence interval [CI] 1.007 to 1.15; p  = .03), previous trauma (OR 2.828, 95% CI 1.017 to 7,867, p  = .042), a weak dorsalis pedis pulse (OR 2.72, 95% CI 1.17 to 6.30, p  = .02), trimming type (OR 2.3, 95 CI 1.06 to 4.98), p  = .35), onychogryphosis (OR 9.036, 95% CI 2.34 to 34.87, p  = .001), and subungual hyperkeratosis (OR 4.3, 95% CI 1.99 to 9.3, p  = .001) were predictive variables for ingrown nails in our population. The incidence of onychomycosis was significantly greater in patients with ingrown nails ( p  = .032) than in patients without ingrown nails. The nail curvature ratio was greater in the patients with ingrown nails than in the group with normal nails. Arterial Doppler ultrasound examinations showed peripheral arterial disease in 19 patients (46.9%) with ingrown nails. The prevalence of ingrown nails was greater in the patients with DM than in the healthy population. Our results indicate that nail type, nail morphology, and diabetic vasculopathy affect the formation and evolution of ingrown nails. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: Peripheral insensate neuropathy is one of the most commonest and the earliest forms of peripheral neuropathy. It is one of the leading causes of the disability in working population who are at risk. Methods: A study was conducted in Kasturba medical college (Manipal university) in the year 2009-12, which included examination of 818 people of more than 30yrs of age by random sampling method who were attending the outpatient clinic. A monofilament was used to determine the peripheral insensate neuropathy, which was defined by the presence of one or more insensate areas. Results: In our study , the prevalence of peripheral insensate neuropathy was 16.2 % ( p-0.0001), among which 9.7% were males and 7.5% were females. The males were 1.27 times significantly at a higher risk than the females , even after a height adjustment to the gender difference in height. As the height increased, the prevalence of peripheral insensate neuropathy increased, irrespective of the diabetic and hypertensive statuses. The risk of the peripheral insensate neuropathy increases at a height of >167 cm in males and at a height of >159 cm in females. Conclusion: The authors conclude that body height is an important and an independent risk factor for peripheral insensate neuropathy, irrespective of co morbidities. Height as a marker, helps the health care professionals in identifying the people who are at risk for peripheral insensate neuropathy

Introduction: Peripheral insensate neuropathy is one of the most commonest and the earliest forms of peripheral neuropathy. It is one of the leading causes of the disability in working population who are at risk. Methods: A study was conducted in Kasturba medical college (Manipal university) in the year 2009-12, which included examination of 818 people of more than 30yrs of age by random sampling method who were attending the outpatient clinic. A monofilament was used to determine the peripheral insensate neuropathy, which was defined by the presence of one or more insensate areas. Results: In our study, the prevalence of peripheral insensate neuropathy was 16.2 % ( p-0.0001), among which 9.7% were males and 7.5% were females. The males were 1.27 times significantly at a higher risk than the females, even after a height adjustment to the gender difference in height. As the height increased, the prevalence of peripheral insensate neuropathy increased, irrespective of the diabetic and hypertensive statuses. The risk of the peripheral insensate neuropathy increases at a height of >167 cm in males and at a height of >159 cm in females. Conclusion: The authors conclude that body height is an important and an independent risk factor for peripheral insensate neuropathy, irrespective of co morbidities. Height as a marker, helps the health care professionals in identifying the people who are at risk for peripheral insensate neuropathy. [ABSTRACT FROM AUTHOR]

Introduction – Regarding the major role of sensory neuropathy in diabetic foot ulcers, the use of an appropriate screening test for early detection of this neuropathy has a crucial role in the management of diabetic foot disorders. As there were no previous studies that performed all screening tests in the same group of patients, we performed all tests in a single group of diabetic patients and compared them to find out the possible differences between the results. Methods – A total of 142 diabetic outpatients at Shariati Teaching Hospital were chosen by systematic randomized selection. Different screening tests for detecting neuropathy in diabetic foot such as symptom and sign scores, Michigan Neuropathy Disability Score (MNDS), and testing by a monofilament were performed for each patient. Results – According to the neuropathy symptom score, 54.9% of the patients were neuropathic, their score was higher than 5, and by neuropathy sign score, 10.1% were neuropathic with a score higher than 6. Regarding MNDS, 42.7% of the subjects were neuropathic, with a score higher than 3. Finally, 23.9% were unable to sense at least one point in the monofilament examination. Conclusions – There were obvious differences between the results of different methods in our study. However, there were significant correlations between them, except between sign and symptom score methods. For determining the most reliable screening test, further studies are needed to compare these methods with a gold standard test and reveal the specificity and sensitivity of these tests. [ABSTRACT FROM AUTHOR]

Abstract: We studied the number of testing sites and the proportion needed to be insensate for the optimal assessment of foot ulcer risk with the 10g monofilament. Also, we compared the sensitivity and specificity of the 10g monofilament with other methodologies. Fifty-two individuals with either a current foot ulcer, a history of a foot ulcer or the presence of Charcot neuroarthopathy and 51 individuals with no history of any of these conditions were assessed with the 10g monofilament at four sites on each foot, the 128Hz tuning fork at the halluces, the Biothesiometer at the halluces and the modified neuropathy disability score. Sensitivities and specificities were calculated for the various modalities. The Biothesiometer and the neuropathy disability score had the highest sensitivities (0.92 for both). The 128Hz tuning fork tested only at the halluces (criterion: ≥1 insensate site) had the same sensitivity (0.86) as the 10g monofilament tested at eight sites (criterion: ≥1 insensate site) with similar specificities (0.56 and 0.58, respectively). The Biothesiometer and the modified neuropathy disability score tend to be more sensitive than the 10g monofilament for the assessment of individuals at risk for foot ulcers. The 128Hz tuning fork tested at only two sites is as sensitive as the 10g monofilament tested at eight sites. These data suggest that the 10g monofilament may not be the optimum methodology for identifying individuals at risk of foot ulcers. [Copyright &y& Elsevier]