The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. A prospective study.

Abstract

OBJECTIVE--To assess the ability of vibration perception threshold (VPT) to predict the development of diabetic foot ulceration. RESEARCH DESIGN AND METHODS--A prospective follow-up study of consecutive patients with vibration perception measured by biothesiometry from April 1988 to March 1989. Patients were stratified in various risk groups. RESULTS--Patients with a VPT < 15 V had a cumulative incidence of foot ulceration of 2.9% compared with 19.8% in patients with a VPT > 25 V, odds ratio (OR) 7.99 (3.65-17.5, 95% confidence intervals), P < 0.01. The incidence of ulceration increased with duration of diabetes, but even with this effect removed, the excess of ulceration persisted, OR 6.82 (2.75-16.92), P < 0.01. CONCLUSIONS--VPT is an effective predictor of the risk of foot ulceration in diabetes and therefore could be used to target foot-care education to those patients most likely to benefit and, thereby, possibly improve its effectiveness.