The tactile circumferential discriminator. A new, simple screening device to identify diabetic patients at risk of foot ulceration.
OBJECTIVE
To evaluate the tactile circumferential discriminator (TCD) (Tacticon Medical Enterprises, West Chester, PA), a new, simple, handheld quantitative sensory testing device, in the identification of patients at potential risk of neuropathic ulceration.


METHODS
Patients with diabetes (n = 133) attending the Manchester Diabetes Centre or diabetic foot clinic seen within a 5-week period were assessed using the TCD, monofilaments, and vibration perception threshold (VPT) measured over the hallux. The sensitivity and specificity of each method in the identification of "high-risk" patients were compared.


RESULTS
The TCD was easy to use, and there was a highly significant correlation between the results obtained compared with both filaments and VPT (P < 0.0001). Similarly, in the identification of patients at risk of ulceration, the TCD agreed with VPT in 75.2% of cases and with the monofilaments in 78.9%. In the identification of the 37 foot ulcer patients, TCD was highly sensitive (100%) but less specific (58.3%) than VPT (86.5%; 79.2%) and the monofilaments (91.9%; 76.0%).


CONCLUSIONS
These data suggest that the TCD is a simple and reliable new technique for population screening for neuropathy and foot ulcer risk.
Vileikyte
L
L
Department of Medicine, Manchester Royal Infirmary, U.K.
Hutchings
G
G
Hollis
S
S
Boulton
A J
AJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D005260:Female; D016523:Foot Ulcer / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000295:instrumentation; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012684:Sensory Thresholds; D014110:Touch