Diabetic foot screening: new technology versus 10g monofilament

The objective was to determine if new technology could provide feedback to the clinician when a 10g force had been delivered. Using a novel electronic force sensor, clinical longevity and the potential for reduced force delivery were assessed under laboratory conditions. Subsequent inter- and intrareliability data were generated and compared with the existing World Health Organization clinical standard (10g monofilament). A total of 20 subjects were trained in the use of the 10g monofilament (Bailey Instruments, Salford Quays, UK) and prototype electronic force sensor (Exsensus, UK). A total of 2000 applications (n = 100 per subject) were administered to a calibrated target at a controlled rate, while time and force histories were captured on a digital storage oscilloscope and data recorder for statistical analysis. Engineering standards in accordance with the American Society for Testing and Materials were applied throughout the experiment. No significant differences in mean peak, median peak, interquartile range, and total range of pressure forces were observed for the electronic force sensor. Alternatively, significant differences for mean and median peak forces were present in the 10g monofilament (P < .05 and P < .01). Post hoc analysis further showed the monofilament to degrade significantly at ≤30 applications (P = .013). Forces delivered by the electronic force sensor appear to be significantly less susceptible to mechanical variability than those provided by monofilaments, thus increasing longevity. Similarly, this new technology provides objective feedback as to when the device is functioning correctly and potentially negates the need for fiber rest periods.