Assessing the sensory status of the diabetic foot

Loss of protective pain sensation (peripheral neuropathy) is well recognised as a complication of diabetes mellitus that plays a major role in the development of foot ulceration (International Working Group on the Diabetic Foot, 1999). As many as 15% of people with diabetes will develop a foot ulcer during their lifetime (Plank et al, 2003); moreover, foot ulceration precedes amputation in approximately 85% of nontraumatic cases (Bird et al, 1999). Figures suggest that 50% of patients attending diabetic foot clinics will have peripheral neuropathy (Baker et al, 2005); thus, it is imperative that individuals with diabetes receive regular assessment of foot sensation (neurological assessment). An annual neurological review will allow early identifi cation of sensory loss and prompt intervention to prevent deterioration (International Caroline McIntosh is Senior Lecturer in Podiatry, University of Huddersfi eld, Yorkshire Sensory loss is a major contributory factor to foot ulceration in people with diabetes mellitus. Evidence suggests that ulcer risk is increased seven fold in the insensate foot (Buchman, 2005). Loss of the protective pain sensation can result in unnoticed trauma to the feet. For example, blisters from ill-fi tting footwear can precede ulceration in the diabetic foot. This article will describe how to assess the sensory status of the feet in patients with diabetes. 140 Wound Essentials • Volume 1 • 2006 Working Group on the Diabetic Foot, 1999; Department of Health, 2001; Scottish Intercollegiate Guidelines Network [SIGN], 2001; National Institute for Health and Clinical Excellence [NICE], 2004)