Diabetic peripheral neuropathy (DPN) is one of the most important risk factors of diabetic foot ulcers, and early detection and treatment are crucial. Simple and cost-effective tests such as the Ipswich Touch Test (IpTT) [7-13] and VibratipTM [14,15] appear ideal candidate methods for LOPS screening in patients with diabetes.

The Ipswich Touch Test involves lightly touching the tips of the right first, second, and fifth toes with the index finger in a specified sequence.

Sensitivity

Ipswich Touch Test (IpTT) is a simple and inexpensive method to screen for loss of protective sensation in diabetic foot patients. It has been shown to be superior to 10 g monofilament and has high specificity.

The test involves lightly touching or resting the index finger for 1-2 seconds on the tips of the first, second, and fifth toes and the dorsum of the hallux of both feet. The patient is asked to tell whether or not they feel the finger and instructed not to push, prod or tap the area. The test can be taught to anyone and is especially easy for non-professionals, such as diabetes nurses, to perform in hospital and in home settings.

Results of a meta-analysis of five studies show that IpTT has a good sensitivity when compared with other methods, and a higher sensitivity than the vibration perception test. Its positive predictive value is also high compared to the monofilament and Tuning Fork 128 Hz tests.

IpTT requires no special equipment and can be performed quickly, without requiring the patient to remove their socks or shoes. It can be used by non-professionals and is simple to use, but needs to be rigorously tested for its ability to detect DPN. This would include screening for DPN in the community, in hospitals and in Third World countries, where other sensory tools are unavailable.

Specificity

Screening for the presence of loss of protective sensation (LOPS) in the feet is a critical step to prevent DPN and reduce hospital-acquired foot ulcers (DFU). Simple, cost-effective tests such as the Ipswich touch test (IpTT) and VibratipTM appear ideal candidate methods for LOPS screening in the community and austere clinical environments. However, their performance in populations without DFU history has not been established.

IpTT involves lightly touching each of the five toes of both feet in a designated sequence with a clean, ungloved finger. Each point is touched only once for a maximum of a few seconds. If the test is positive, the person should be referred to a diabetes specialist podiatrist or the diabetes foot clinic for further assessment.

Results of the meta-analysis demonstrated that IpTT has a good sensitivity when compared to 10 g monofilament for detecting LOPS, with a sensitivity of between 51 and 83.9%. The Ipswich Touch Test also has a good specificity, with a specificity of between 76 and 100%. The Ipswich Touch Test also has a high level of agreement between raters, with kappa values of 0.97 to 0.83.

The Ipswich touch test is easy to administer and requires no special equipment. It can be used in a variety of settings and may be more acceptable to patients than other sensory tests. This may facilitate its uptake and use in routine diabetic foot care.

Accuracy

Diabetic foot ulcers are one of the leading causes of morbidity and mortality in people with diabetes. Early detection of the loss of protective sensation (LOPS) in the feet is vital for preventing the progression of this condition and reducing the incidence of hospital-acquired diabetic foot ulcers. The Touch your Toes test, also known as the Ipswich touch test, is a simple, inexpensive, and easy to use screening tool for LOPS in people with diabetes.

This study aimed to assess the sensitivity and specificity of the Ipswich Touch Test compared with the standard monofilament test for identifying LOPS in patients with diabetes. The Ipswich Touch Test is a simplified test that involves touching each of the toes on both feet with a clean finger in a designated sequence. The authors of the study believe that this technique may be a useful alternative to current methods for testing for LOPS, such as tuning forks and patellar hammers, which require expensive equipment and regular replacement.

The researchers conducted a cross-sectional study at the ambulatory clinic of a large academic tertiary care facility with a diabetes specialty in Toronto, Canada. Sixteen interprofessional health-care providers, including 3 chiropodists, 2 dietitians, 6 nurses, 1 physiotherapist, and 1 endocrinology resident, assessed the participants in a randomized order using the Ipswich Touch Test and the standard monofilament test to measure sensitivity and specificity for the two tests. The Ipswich Touch Test was found to be accurate compared with the standard monofilament in detecting LOPS, and is therefore an excellent screening tool for diabetic neuropathy in the community.

The Ipswich Touch Test (IpTT) is a simple, inexpensive and easy to teach test for the presence of neuropathy in diabetic patients. It involves touching (not pushing or poking) the tips of the right first toe, right fifth toe, left third toe and left fifth toe in a specific sequence with a clean ungloved index finger. The test can be performed at home by a person with diabetes and their family members. It has been shown to be an effective screening tool for the presence of LOPS in people with DM.

The aim of this study was to investigate the sensitivity and specificity of the Ipswich Touch Test in identifying DPN. Participants included people with Type 1 and Type 2 diabetes who attended the general diabetes clinic at The Ipswich Hospital NHS Trust. The majority of the participants had been diagnosed with diabetes for more than 10 years and were able to consent to take part in this research.

The Ipswich Touch Test is an ideal method for screening for LOPS in people with diabetes at home and can be used by a person with diabetes and their family. Unlike other established screening methods such as tuning forks and monofilaments, the Ipswich Touch Test requires no specialist equipment and is easily sterilized by hand washing. The Ipswich Touch Test is also cost-effective and could be administered by healthcare staff tasked with providing pressure relief to the feet of diabetic inpatients, as well as community health workers.