Biomechanics Research Today is a free monthly online journal that collates and summarizes the latest research about Biomechanics, including details on mechanics of living organisms, movement, locomotion, prosthetic limbs.

The steel ball-bearing test: a new test for evaluating protective sensation in the diabetic foot.

Papanas N, Gries A, Maltezos E, Zick R

Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece. papanasnikos@yahoo.gr

AIMS/HYPOTHESIS: 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/INTERPRETATION: 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.

Published 9 March 2006 in Diabetologia, 49(4): 739-43.
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