The Ipswich Touch Test A simple and novel method to identify inpatients with diabetes at risk of foot ulceration

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 (kappa = 0.88, P < 0.0001). Interrater agreement for the IpTT was substantial (kappa = 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.