The Ipswich Touch Test: a simple and novel method to identify inpatients with diabetes at risk of foot ulceration.

Abstract

To promote foot screening of inpatients with diabetes, we simplified sensory testing to lightly touching the tips of the first, third, and fifth toes (the Ipswich Touch Test [IpTT]). Respective performances of the IpTT and 10-g monofilament (MF) were compared with a vibration perception threshold of ≥25 V indicating at-risk feet in 265 individuals. The IpTT and MF were also directly compared. With ≥2 of 6 insensate areas signifying at-risk feet, sensitivities and specificities, respectively, were IpTT (77 and 90%), MF (81 and 91%); positive predictive values were IpTT (89%), MF (91%); and negative predictive values were IpTT (77%), MF (81%). Directly compared, agreement between the IpTT and MF was almost perfect (κ=0.88, P<0.0001). Interrater agreement for the IpTT was substantial (κ=0.68). The IpTT performs well against a recognized standard for ulcer prediction. Simple to teach, reliable, without expense, and always at hand, it should encourage uptake of screening and detection of high-risk inpatients requiring foot protection.