Screening for patients at risk of diabetic foot ulceration in a general diabetic outpatient clinic

Diabet Med. 1996 Jun;13(6):561-3. doi: 10.1002/(SICI)1096-9136(199606)13:6<561::AID-DIA112>3.0.CO;2-P.


An examination of the reproducibility of three tests for identifying patients at risk of diabetic foot complications is reported. One thousand and one patients attending a general diabetic outpatient clinic at the Royal Liverpool University Hospital underwent screening using the Semmes-Weinstein monofilaments, the biothesiometer, and palpation of pedal pulses. Two hundred and fifty-nine patients who were found to have a deficit on at least one of these tests were given a second appointment where the tests were repeated. Two hundred and twenty-nine patients attended for their second appointment. The expected range of variation in readings for the biothesiometer was 5 log hertz, sufficient variation to make the biothesiometer unacceptable as a screening instrument. The range of reproducibility for the four pedal pulses was from 68% to 81%, also an unacceptable level of variation. Over 85% of the results for the Semmes-Weinstein monofilaments were the same on the first and second measurement. Of the three instruments examined in this study, only the Semmes-Weinstein monofilaments have sufficient reproducibility in the clinical setting for them to be recommended for general use as a screening test for risk of diabetic foot complications.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Ambulatory Care / methods*
  • Diabetic Foot / diagnosis*
  • Evaluation Studies as Topic
  • Female
  • Humans
  • Male
  • Mass Screening*
  • Middle Aged
  • Pulse
  • Reproducibility of Results
  • Risk Factors
  • Sensory Thresholds
  • Vibration