The Ipswich Touch Test
A simple and novel method to identify inpatients with diabetes at risk of foot ulceration
Gerry Rayman, MD1⇓, Prashanth R. Vas, MBBS1, Neil Baker, DPN1, Charles G. Taylor, Jr., MBBS, MSC1, Catherine Gooday, PGDIP2, Amanda I. Alder, MD, PHD3 and Mollie Donohoe, MD4
1Diabetes Research Centre, Ipswich Hospital National Health Service Trust, Suffolk, U.K.
2Department of Podiatry, Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norfolk, U.K.
3Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, U.K.
4Diabetes and Endocrinology, Royal Devon and Exeter National Health Service Foundation Trust, Exeter, U.K.
Corresponding author: Gerry Rayman, gerry.rayman@ipswichhospital.nhs.uk.
Abstract
OBJECTIVE 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]).
RESEARCH DESIGN AND METHODS 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.
RESULTS 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).
CONCLUSIONS 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.