Foot Sensation Testing in the Patient With Diabetes

Abstract: Introduction. Sensory testing of patients with diabetes is an integral part of preventing new and recurrent wounds. The Semmes-Weinstein monofilament (SWM) test is considered the gold standard to screen for loss of protective sensation; however, the authors’ experience has shown that it is not only time consuming, but is of negligible value for a patient with a diabetic foot ulcer (DFU).


Methods. This article discusses the shortfalls with regard to the SWM test and reviews other techniques for sensory evaluation. In addition, the Quick & Easy system is introduced, which combines sensory assessment with guidance for anesthesia requirements during wound debridements or other surgical interventions. Results. A scale ranging from grade 2 (normal sensation) to grade 0 (absent sensation) reflects the patient’s responses to wound manipulation, palpation of an underlying deformity, and/or evaluation of the difference between light touch sensation with the patient’s hands compared to the feet. For patients with total loss of sensation (grade 0), no anesthesia is needed for surgical procedures. If there is diminished sensation (grade 1), surgical intervention can be performed following administration of either topical or local anesthesia. For patients with normal sensation (grade 2), complete anesthesia of the surgical site will be required. A preliminary observation was conducted on 50 patients with DFUs using the Quick & Easy system. Anesthetic requirements were accurately predicted in all cases without the need to modify the type of anesthesia during the procedure. Conclusion. The Quick & Easy system serves as a simple sensory evaluation for a patient with a DFU and provides valuable anesthesia guidance for wound care procedures … read more