A team of clinicians at St. Michael’s Hospital is testing a new way to assess patients for diabetic peripheral neuropathy, a loss of sensation in the feet that can result in an inability to feel pain.
Between 60 and 70 per cent of individuals with diabetes lose sensation in their feet, increasing their risk of foot ulcers, which can lead to infection and leg amputation.
The most common test for neuropathy is the monofilament test, which involves placing an instrument similar to a fishing line on areas of the foot, and asking if the patient feels sensation. But a much simpler test, called the Ipswich Touch Test, could be carried out at no cost, without the use of a special tool.
“This test could be used anywhere by anyone, meaning there would be no reason not to check patients with diabetes for neuropathy,” said Ann-Marie McLaren, a chiropodist in the Wound Care Department, who proposed and developed the study. “We’re looking for a tool that can easily identify people with loss of sensation who are at risk for developing a foot ulcer.”
The Ipswich Touch Test, developed by Dr. Gerry Rayman in the U.K., involves examiners using their index finger to touch the tips of the patients’ first, third and fifth toes on both feet in a particular order. Patients are asked to close their eyes and identify when the toe is touched.
“About 85 per cent of people who get their legs amputated had a diabetic ulcer, which they developed because they couldn’t feel their feet,” said Suzanne Lu, a chiropodist in the Mobility Program. “If we can put into practice a simple assessment tool, that means we could start catching people who have neuropathy earlier on, and prevent these kinds of things from happening.”
The study team trained 16 clinicians to use both the Ipswich Touch Test and the monofilament test on eight diabetic patients at St. Michael’s. The team is trying to validate the Ipswich Touch Test to determine whether it could be used in various clinical settings among different health-care professionals including nurses, chiropodists, occupational therapists, physiotherapists, dieticians and physicians.
“We want to see if we can get agreement between the monofilament and Ipswich Touch tests, and see if the touch test works between different health-care practitioners, across different clinical areas,” said McLaren. “With simple screening methods, early recognition of loss of sensation, education and appropriate referrals, we can prevent patients from developing foot complications and save limbs – that’s the ultimate goal.”
Corinne Ton That works in communications at St. Michael’s Hospital in Toronto.
How it works: the Ipswich Touch Test
- Patients are asked to close their eyes
- Examiners lightly touch three toes on both feet
- Toes are touched in a particular sequence using the index finger
- Patients are asked to indicate if they feel the examiner’s finger on their toes