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).