12/3/2023 0 Comments Tuning fork test foot![]() Subjects were evaluated in the sitting position. No individuals presented with any kind of insensitivity.Įvaluation with the new monofilament was compared to the commercially available monofilament. To exclude the presence of abnormalities in lower limb sensations in this group, all individuals submitted to a clinical evaluation using vibration perception (128 Hz tuning fork) at two sites (hallux pulp and malleolus) and point pressure (Semmes-Weinstein 10 g monofilament) at five sites (halux, 3 rd toe, 1 st, 3 rd, and 5 th metatarsal heads). The diabetes criteria used to select this group followed the ADA (American Diabetes Association) diabetes diagnosis criteria. We proceeded with the clinical evaluation of this filament in 100 healthy (56 male and 44 female), non-diabetic medical students and physicians from the State University of Sao Paulo who volunteered for the study. In the second phase, we evaluated the chosen line, referred to here as the “white-line”, in relation to the commercially available (SORRI-BAURU), referred to here as the “yellow-line”. This step was done inside the laboratory using a precision digital scale (OHAUS Max model – capacity = 210 g/d = 1 mg). the only holding structures could be the thumb and index finger of the examiner. If possible, we identified lines that did not require any other device for clinical use, i.e. Initially, we assessed the fishing lines available in the national market that presented bending characteristics similar to the 10 g monofilament. It was approved by the Local Ethics in Research Committee (CAPPesq n° 1184/09) and informed consent was obtained from all subjects who agreed to participate. This was a prospective, investigative, non-interventionist study with minimal risk to the participants. The objective of this study was to identify a similar nylon line and compare it to the commercially available one. 13 In Brazil, the 10 g monofilament is produced locally, but is not always available for purchase. The main characteristic of this line is that it exerts a 10 g pressure when bent (4 cm length by 500 μm diameter N° M-1425, South Bend Inc. showed the effectiveness of the “house made” monofilament, constructed from a fishing line, for screening for diabetic foot. 12 Its reproducibility and predictive value lead the World Health Organization (WHO) and the International Diabetes Federation (IDF) to recommend its use in clinical practice. 11 This method was refined and currently a 10g nylon monofilament, developed by Semmes and Weinstein, is accepted as the gold standard for detecting ulcer risk. 9,10 One of the first studies looking to improve touch sensitivity screening dates back to 1898 and used a horsehair attached to a thorn. It is important to consider that in the final phases of the disease the patient may present with a completely insensitive foot. Peripheral sensory-motor neuropathy, which is responsible for the progressive loss of protective and proprioceptive sensations, is considered the main agent of the clinical abnormalities found in diabetic foot patients. 5–7 Recognition of individuals at risk for ulceration, followed by adequate intervention, may reduce the chance of unfavorable results up to 80%. 1–4 In Brazil, amputation, admission, ulceration, and cost data are similar to other Western countries. It is a health issue affecting several countries and represents a significant socioeconomic problem. Post-amputation mortality is extremely high, with a three-year survival rate of 65% and a five-year survival rate of 41%. Diabetic foot is the leading cause of non-traumatic lower limb amputations in the world, resulting in an amputation risk for diabetic patients that is approximately 40 times greater than that of the general population. Approximately 20–25% of all diabetic patients will present with lower extremity ulceration at some time in their lives. Diabetic foot is considered to be one of the most serious complications for patients suffering from Diabetes Mellitus (DM).
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