Ipswich Touch Test

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The Ipswich Touch Test (IpTT) is a simple screening test for diabetic sensory neuropathy that has been shown to have good sensitivity and specificity for detecting the loss of sensation in the diabetic foot. It was developed by Gerry Rayman and colleagues at the Ipswich Hospital in Suffolk, UK. He developed the test in response to the inadequate screening of the feet of those with diabetes admitted to hospital by junior doctors. This led to a significant reduction in heel ulcers at the hospital (press report).

The Ipswich Touch Test is carried out by lightly touching the tips of the first, third and fifth toes of both feet (six toes) with the examiner’s index finger for 1-2 seconds. The patient has their eyes closed and is asked to identify when the toe is touched. Do not push harder if they do not feel it and only touch each toe once. Reduced foot sensation using this test is generally defined as there being ≥ 2 insensate areas.

Research on the Ipswich Touch Test:

Rayman et al (2011)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 [k] = 0.88, P < 0.0001). Interrater agreement for the IpTT was substantial (k = 0.68).Performed well compared to monofilaments and vibration threshold
Bowling et al (2012)The vibration perception threshold and Neuropathy Disability Score tests exhibited almost perfect agreement with each other (P < 0.001). The VibraTip and Ipswich Touch Test results were identical (P < 0.001). The VibraTip and Ipswich Touch Test results also exhibited almost perfect agreement with the vibration perception threshold (P < 0.001) and the Neuropathy Disability Score(P < 0.001).
Madanat et al (2014)IpTT was sensitive and specific in detecting feet at risk compared to VPT ≥ 25 V; IpTT was highly specific in detecting the risk of foot ulceration compared to NDS ≥ 6; IpTT was highly specific compared to10-g MF test and showed substantial agreement.
Sharma et al (2014)Of 331 patients (174 males), 25.1% (n = 83) had ≥ 2 insensate areas to 10-g monofilament testing. Compared with this, the Ipswich Touch Test at home had a sensitivity of 78.3% and a specificity of 93.9%. The predictive values of detecting ‘at-risk’ feet were positive at 81.2% and negative at 92.8%. The likelihood ratios were positive at 12.9 and negative at 0.23.
Steurer (2015)Had patients carry out the IpTT at home by a friend or family member; compared results to clinical testing; found 100% agreement between home IpTT test and clinical tests.In German
Basir et al 2020"We found sensitivity of IpTT against Pin prick test was 80.0%, with specificity 88.0% in detection small fiber neuropathy. Meanwhile, sensitivity of IpTT to detect large fiber neuropathy in comparison with Monofilament (80.0%), Tuning Fork 128 Hz (40.0%), and Ankle Reflex (20.0%)."
Hu et al 2020"Five studies that reported the sensitivity and specificity of the Ipswich touch test were included. When compared to the 10 g monofilament, the sensitivity ranges from 51 to 83.3% and the specificity ranges from 96.4 to 98%. When compared to the vibration perception test ≥25 V, Ipswich touch test sensitivity ranges from 76 to 100% and specificity ranges from 90 to 96.6%."Systematic review
Senthilkumar et alConclusion: "10gm-SMWFis a better test to diagnose neuropathy than the IpTT; but in the absence of 10gm-SMWFs, the IpTT is an ideal alternative. "
Diabetes UK had a campaign called Touch the Toes Test using the Ipswich Touch Test to identify people at risk for diabetic foot complications.

External Links:
The Ipswich Touch Test for diabetic neuropathy (Podiatry Arena)

Related Topics:
Diabetic Foot Assessment | The 3 Minute Diabetic Foot Exam | Methods of Sensory Assessment | 60 Second Diabetic Foot Screen Tool | Comprehensive diabetic foot exam (CDFE)

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