The Slipping Slipper Sign: A Poor Man’s Test for Severe Diabetic Peripheral Neuropathy (original) (raw)
Related papers
Journal of Iranian medical council, 2022
Background: Some clinical scoring systems as the quantitative tools have been developed to assess the presence and severity of Diabetic Peripheral Neuropathy (DPN) based on both the patient's complaints and the physicians' findings. This study was aimed at assessing the presence and severity of sural and peroneal nerve neuropathies using Michigan Neuropathy Screening Instrument (MNSI) and United Kingdom Screening Test (UKST) questionnaire compared with electrodiagnosis assessments. Methods: 148 patients with Diabetes Mellitus (DM) including 80 females and 68 males with a mean age of 57.6, 19 type 1DM and 129 type 2 DM were recruited in this study. The findings of the electrophysiological study such as peroneal and sural nerves' conduction delay, velocity and amplitude were gathered. The patients were also assessed regarding the clinical neuropathy status using the two instruments of MNSI and UK. Results: The mean neuropathy score of MNSI and UKST were 2.2 (1.7) and 4.1 (3.0), respectively. Each instrument detected the DPN in 47.3% and 64.9% of the patients, respectively. Also, based on the nerve conduction studies (NCS), the neuropathy of sural and peroneal nerves was found in 54.1% and 79.7%, respectively. Unlike the peroneal nerve, there was a significant agreement between the electrodiagnosis assessment and the screening tools in the diagnosis of sural nerve neuropathy. Conclusion: Given that NCS is a practical, simple, and non-invasive approach and also can determine the level of damage and regeneration in peripheral nerves, sural nerve conduction study is suggested as a convenient option for screening and diagnosing the diabetic neuropathy.
Clinical Neurophysiology, 2008
Objective: Clinical utility of nerve conduction studies (NCS) of the medial plantar and dorsal sural nerves in the early detection of polyneuropathy have already been shown separately. However, at present, there is no data about the combined assessment of these two nerves in distal sensory neuropathy. In the present study, we aimed to evaluate the medial plantar and dorsal sural NCS in a group of diabetic patients with distal sensory neuropathy (DSN) and in healthy controls. Methods: Thirty healthy and 30 diabetic adult patients were included. In all subjects, peripheral motor and sensory NCS were performed bilaterally with surface electrodes on the lower limbs including medial plantar and dorsal sural nerves. In addition, motor and sensory nerves were studied unilaterally on the upper limb. Results: In all patients, nerve action potential (NAP) amplitudes of sural and superficial peroneal nerves were within normal ranges, but in the patient group mean value was significantly lower than in the controls. Among clinically defined 30 DSN patients, medial plantar NAP amplitude was abnormal in 18 (60%) and dorsal sural nerve amplitude was abnormal in 13 (40%) of the patients bilaterally. Additionally, the onset NCV of the dorsal sural nerve was significantly slower in patients than controls (P = 0.038). Evaluation of both of these nerves increased the sensitivity up to 70% in the detection of neuropathy.
Journal of Diabetology, 2014
To identify the feet at risk of developing foot ulceration in asymptomatic Type 2 diabetic patients using vibration perception thresholds. This study was conducted at Baqai Institute of Diabetology & Endocrinology (BIDE) over a period of 12 months from October 2009 to September 2010. A total of 99 patients were selected from the outpatient department after obtaining informed consent. Detailed history, physical examination including foot examination was carried out. All asymptomatic patients with Type 2 diabetes were considered eligible to participate in the study of Vibration Perception Threshold (VPT) obtained by Neurothesiometer. A cut off value of 25 V was used to identify feet at risk. Patients with Type 1 or Type 2 diabetes having present or previous history of foot ulcer, patients above 70 years of age, having painful neuropathy, chronic renal disease, chronic liver disease or congestive heart failure were excluded from the study. Out of 99 patients, 49 were males and 50 were females. More than half were above the age of 40 years, 33 subjects were between 40-50 years of age followed by 30 subjects in the age group of 51-60 years. Mean duration of diabetes was 7.65 ± 5.51 years. 10% of subjects showed VPT > 25. Among different variables, only duration of diabetes showed significant correlation with increased VPT. This study concludes that a significant number of asymptomatic Type 2 diabetic patients may have early stage of sensory neuropathy. VPT is an effective tool for identifying feet at risk of foot ulceration in asymptomatic patients.
Archives of Medical Science, 2016
Introduction: New tests for improved diagnosis of diabetic peripheral neuropathy (DPN) are useful. Material and methods: We evaluated the utility of automated nerve conduction study (NCS) of the sural nerve with a new portable device for the diagnosis of DPN in patients with type 2 diabetes mellitus (T2DM). This study included 114 T2DM patients (58 men) with mean age 64.60 ±8.61 years. Exclusion criteria were B 12 depletion, alcohol abuse and other causes of peripheral neuropathy. The reference method was the Neuropathy Disability Score (NDS) with a threshold NDS ≥ 3. Sural nerve automated NCS was carried out with the portable NC-stat DPNCheck device. Sensory nerve conduction velocity and sensory nerve action potential amplitude were measured bilaterally. Automated NCS was considered abnormal when ≥ 1 of the two aforementioned neurophysiological parameters was abnormal in at least one leg. Results: Examination with NC-stat DPNCheck exhibited 90.48% sensitivity, 86.11% specificity, 79.17% positive predictive value (PPV) and 93.94% negative predictive value (NPV). The positive likelihood ratio (LR+) was 6.51 and the negative likelihood ratio (LR-) was 0.11. Conclusions: Sural nerve automated NCS with the NC-stat DPNCheck device exhibits high sensitivity and specificity for the diagnosis of DPN in T2DM.
Clinics and practice, 2012
This study evaluated the ability of the slipping slipper sign (defined as unknowingly losing a slipper while walking) to identify diabetic neuropathy in Jamaican patients. A single question was used to ascertain the presence of the slipping slipper sign (SSS) among 69 patients attending a diabetes clinic. Nurses assessed pain, vibration and pressure perception among the same patients in order to detect diabetic neuropathy. The sensitivity, specificity and positive predictive value for the SSS were calculated. Eight participants (men=5, women=3) reported positive SSS. The SSS had a sensitivity of 28.6%, specificity of 100% and positive predictive value (PPV) 100% for neuropathy on at least one of the three tests. These findings indicate that the SSS has high specificity and PPV for diabetic neuropathy but the sensitivity is low. The sign may be a useful adjuvant to conventional methods of screening for severe neuropathy.
International Journal of Contemporary Medical Research [IJCMR]
Introduction: Peripheral neuropathy is the commonest incapacitating complication of diabetes mellitus. Many of the patients are asymptomatic for neuropathy thus developing diabetic foot and ulceration, ultimately leading to amputation. Study aimed to detect subclinical diabetic peripheral neuropathy in early stages by using nerve conduction studies. Material and methods: Cases consisted of one hundred patients of Type 2 Diabetes Mellitus but asymptomatic for peripheral neuropathy. Twenty-five normal, healthy individuals served as controls. The studies of distal latency, amplitude and conduction velocity of motor fibers of right and left peroneal and tibial nerves were performed. Results: There was a statistically significant decrease in motor nerve conduction velocity and prolongation of distal latency for both peroneal and tibial nerves on either side in cases versus controls. The CMAP (compound muscle action potential) amplitude in right and left peroneal nerves was less in cases as compared to controls, which was statistically significant for left side but not for right side. CMAP amplitude was statistically significantly less in cases versus controls for right tibial nerve, but for left tibial nerve there was a statistically insignificant increase. Data are presented as mean ± SD. Results were evaluated by unpaired t-test. A level of P <0.05 was accepted as statistically significant. Conclusion: Nerve conduction studies (NCS) being simple and non-invasive technique can be used routinely to diagnose diabetic neuropathy in early stages so that proper treatment can be instituted to obtain good outcome.
Assessment of sensory neuropathy in patients with diabetic foot problems
Diabetic Foot & Ankle, 2011
Our aim of this study was to compare the accuracy of three different modalities for testing sensory neuropathy in diabetic patients with and without diabetic foot problems. The three devices used included the pin-prick testing using the Neurotip † (PPT), the SemmesÁWeinstein 5.07/10 g monofilament testing (SWMT), and the rapid-current perception threshold (R-CPT) measurements using the Neurometer † testing. Our study population consisted of 54 patients (108 feet) with diabetic foot problems treated at the National University Hospital in Singapore by our multidisciplinary diabetic foot care team. Our results showed no difference in sensory neuropathy detected by PPT and 5.07/10 g SWMT in both the pathological and normal foot. In the pathological foot, there was significant increase in sensory neuropathy detected by the Neurometer † device at both the big toe and ankle sites as compared to PPT and 5.07/10 g SWMT. In the normal foot, there was a significant increase in sensory neuropathy detected by the Neurometer † device at the big toe site only as compared to PPT and 5.07/10 g SWMT. Finally, the Neurometer † measurements detected a statistically higher proportion of feet with sensory neuropathy as compared to detection by the PPT or 5.07/ 10 g SWMT.