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Staged diabetes management a systematic approach - part 9

và thích hợp cho bệnh nhân. Kiểm tra bên trong của giày cho các đối tượng nhỏ (đá, chìa khóa, nút bấm) mà bệnh nhân có thể không có thể cảm thấy. Trong khi việc sử dụng của g 10, monofilament 5,07 được coi là tiêu chuẩn cho tầm soát bệnh lý thần kinh chân | 350 MICROVASCULAR COMPLICATIONS Photo 9.13 Foot examination example of 10 g 5.07 monofilament Photo 9.14 Foot examination toe sensation and appropriate for the patient. Examine the inside of the shoe for small objects rocks keys buttons that the patient may not be able to feel. While the use of the 10 g 5.07 monofilament is considered the standard for screening for foot neuropathy another option is the use of the low-pitched tuning fork 128 Hz to screen for the presence or absence of vibratory sensation in the foot. Loss of vibratory sensation usually precedes the loss of protective sensation measured using Photo 9.15 Foot examination demonstration of appropriate use of 10 g 5.07 monofilament the 10 g 5.07 monofilament allowing for the detection of earlier stages of neuropathy. Proper tuning fork testing is as follows the patient is first taught the difference between pressure from applying the tuning fork and vibration. The tuning fork is placed on the patient s distal interpha-langeal DIP joint on the first finger of the hand when it is not vibrating to demonstrate the concept of pressure followed by application to the same joint with the tuning fork vibrating. The patient is then asked to close their eyes and the vibrating tuning fork is applied to the DIP joint of the unsupported great toe. The patient is instructed to inform the tester when they stop feeling the vibration from the tuning fork. The tuning fork is then placed on the DIP joint on the first finger of the tester and the time until they stop feeling vibration is measured. Note if the tester has neuropathy the patient may serve as his or her own control and the vibrating tuning fork may be placed on the DIP joint of the patient s first finger. If the tester or patient feels the vibration for less than 10 DETECTION AND TREATMENT OF FOOT COMPLICATIONS 351 Photo 9.16 Foot examination heel sensation seconds the patient is considered to have normal vibration sensation. If the tester or patient feels the .