The steel ball-bearing test: a new test for evaluating protective sensation in the diabetic foot.
OBJECTIVE
The aim of the study was to assess a new steel ball-bearing test as a means of evaluating protective sensation in the diabetic foot.


METHODS
Subjects were enrolled for this study as follows: (1) 39 patients (mean age 61.3+/-9.7 years) with neuropathy and prior neuropathic ulcer (Group A); (2) 36 patients (mean age 63.7+/-10.1 years) with neuropathy without neuropathic ulcer (Group B); (3) 34 patients (mean age 52.1+/-10.4 years) without neuropathy (Group C); and (4) 21 healthy volunteers (mean age 46.7+/-8.7 years) (Group D). Neuropathy was diagnosed by means of neuropathy disability score (NDS). The plantar area over the second metatarsal head of each foot was examined with steel ball-bearings of varying diameters. The smallest diameter that the patient could feel was used to define the ball-bearing score (range 1-6).


RESULTS
A high ball-bearing score was significantly more frequent in patients with neuropathic ulceration than in neuropathic patients without ulceration and in diabetic patients without neuropathy (p<0.001). A high score was also more frequent in neuropathic patients without ulceration, than in patients without neuropathy (p<0.001). The ball-bearing score was significantly (p=0.01) correlated with the NDS, the monofilament test, the vibration perception threshold and the thermal perception threshold. The ball-bearing test had a sensitivity of 84% and a specificity of 100% for impaired protective sensation due to neuropathy, and a sensitivity of 84.6% and a specificity of 86.1% for detection of patients with prior neuropathic ulceration.


CONCLUSIONS
The steel ball-bearing test has a high sensitivity and specificity both for the evaluation of protective sensation and for detection of patients with prior neuropathic ulceration.
Papanas
N
N
Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece. papanasnikos@yahoo.gr
Gries
A
A
Maltezos
E
E
Zick
R
R
D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D017719:Diabetic Foot / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013232:Steel; D016474:Weight-Bearing
D013232:Steel