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Evaluation of Pressure Threshold Prior to Foot Ulceration

One- versus Two-Point Static Touch

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  • 1 Institute for Peripheral Nerve Surgery, Baltimore, MD.
  • | 2 Professor of Plastic Surgery and Neurosurgery, Johns Hopkins University, Baltimore, MD; Professor of Surgery, University of Arizona, AZ. Mailing address: Suite 370, 3333 N Calvert St, Baltimore, MD 21218.
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A prospective study of 29 patients with diabetic neuropathy and 47 nondiabetic patients with tarsal tunnel syndrome were evaluated with computer-assisted neurosensory testing at three sites on the foot. The sensitivity and specificity of one-point static touch thresholds for identifying the presence of large fiber axonal loss was done using the calculated thresholds for monofilaments derived from their markings. The sensitivity for one-point static touch in identifying axonal loss was 33% for the 5.07, 38% for the 4.93, 50% for the 4.17, and 60% for the 4.08 monofilament-equivalent, with a specificity of 100% at each level. Therefore, one-point static touch testing, even using monofilaments thinner than 5.07, has a high percentage of false-negative results in identifying patients with axonal loss. (J Am Podiatr Med Assoc 91(10): 508-514, 2001)

Dr. Dellon has a proprietary interest in the Pressure-Specified Sensory Device and in Sensory Management Services, LLC, Baltimore, MD.