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Clinician Article

The Ipswich Touch Test: a simple and novel method to screen patients with diabetes at home for increased risk of foot ulceration.



  • Sharma S
  • Kerry C
  • Atkins H
  • Rayman G
Diabet Med. 2014 Sep;31(9):1100-3. doi: 10.1111/dme.12450. Epub 2014 Apr 11. (Original)
PMID: 24673517
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Disciplines
  • Endocrine
    Relevance - 6/7
    Newsworthiness - 6/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 6/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 6/7
  • Internal Medicine
    Relevance - 6/7
    Newsworthiness - 6/7

Abstract

AIMS: The Ipswich Touch Test is a novel method to detect subjects with diabetes with loss of foot sensation and is simple, safe, quick, and easy to perform and teach. This study determines whether it can be used by relatives and/or carers to detect reduced foot sensation in the setting of the patient's home.

METHODS: The test involves lightly and briefly (1-2 s) touching the tips of the first, third and fifth toes of both feet with the index finger. Reduced foot sensation was defined as = 2 insensate areas. Patients due to attend clinic over a 4-week period were invited by post. The invitation contained detailed instructions and a sheet for recording the results. The findings were compared with those obtained in clinic using the 10-g monofilament at the same six sites.

RESULTS: Of 331 patients (174 males), 25.1% (n = 83) had = 2 insensate areas to 10-g monofilament testing. Compared with this, the Ipswich Touch Test at home had a sensitivity of 78.3% and a specificity of 93.9%. The predictive values of detecting 'at-risk' feet were positive at 81.2% and negative at 92.8%. The likelihood ratios were positive at 12.9 and negative at 0.23.

CONCLUSIONS: With clearly written instructions, this simple test can be used by non-professionals to accurately assess for loss of protective sensation. We believe that the Ipswich Touch Test may also be a useful educational adjunct to improve awareness of diabetes foot disease in patients and relatives alike and empower them to seek appropriate care if sensation was found to be abnormal.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

A simple and very useful test that can empower diabetic patients in appropriate care of their feet and, if positive, prompt them to seek definitive care/podiatry referral.

Family Medicine (FM)/General Practice (GP)

This is an important paper. It has the potential to change the way we deliver care to patients with diabetes -- both in an educational sense and for encouraging better self-care and responsibility for own care.

General Internal Medicine-Primary Care(US)

The "Ipswich Touch Test" is a very simple test that a patient with diabetes or family member can perform at home to assess for loss of sensation in the feet. While the test has only moderate sensitivity, it has good specificity, and is very easy and inexpensive (free) to administer. It seems worthwhile for providers to recomend that high-risk patients practice this assessment at home as part of routine foot care.

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