Why 5 Tests Are Better Than One: Comprehensive Diabetic Foot Screening
A patient sits across you, with a look of quiet concern. “Doctor, my feet feel strange at night. Like they’re burning, but also numb?”
You pull out the trusty biothesiometer, test her vibration sense perfectly normal.
“Everything looks fine,” comes the reassurance, but something nags as she leaves.
Three months later, she’s back.
This time with a diabetic neuropathy complication an ulcer on her left foot that she didn’t even feel forming.
This scenario plays out in clinics across the country more often than healthcare professionals would like to admit.
Despite best intentions and standard diabetic neuropathy screening protocols, something crucial is being missed in neuropathy evaluation.
With 28% of diabetic adults developing peripheral neuropathy and estimates suggesting that up to 50% will eventually be affected, clinicians need to ask themselves: are their biothesiometer assessments comprehensive enough, or are they just not looking in the right places?
The Uncomfortable Truth About Current Approaches
Let’s examine the biothesiometer honestly. It’s been a reliable tool for diabetic neuropathy assessment for decades, and rightly so. Vibration perception testing is non-invasive, reproducible, and provides solid data about large fibre function.
But here’s what should concern every practitioner: they’re essentially using a biothesiometer to test only one type of nerve fibre and calling it a comprehensive diabetic neuropathy evaluation.
For instance, if a patient presented with chest pain, would any clinician only check blood pressure and call it a cardiac workup?
Of course not.
Yet that’s essentially what’s happening with neuropathy assessment.
The problem isn’t that the biothesiometer is inadequate; it’s that diabetic neuropathy is more complex than what any single test can capture. Painful diabetic peripheral neuropathy affects 33.9% of patients, many of whom had normal biothesiometer results just months before their symptoms begin
What's Actually Being Missed
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- Small Fiber Neuropathy: With a prevalence of 13.3 per 100,000, small fibre neuropathy often presents with that exact burning, tingling sensation that the patient in the beginning described. These patients experience pain, temperature sensation loss, and can develop autonomic dysfunction, all while maintaining perfectly normal vibration perception.
- The Protective Sensation Gap: The 10 g monofilament test is recognized as the gold standard for assessing loss of protective sensation and ulcer risk. Yet how often do clinicians actually integrate it seamlessly with vibration testing? Usually, it’s a separate procedure, separate documentation, separate follow-up. This disconnects costs valuable diagnostic opportunities.
- Thermal Dysfunction: Here’s something particularly interesting: temperature sensation abnormalities often manifest before vibration loss. Clinicians are potentially missing a window for earlier intervention simply because thermal thresholds aren’t routinely assessed.
- The Autonomic Component: Skin temperature changes and sudomotor dysfunction reveal significant information about disease progression and complication risk, yet they’re rarely part of standard evaluation protocols.
A Better Way Forward: The Five-Pillar Assessment
After years of experience, forward-thinking clinicians began wondering: what if there was a better approach?
What if instead of separate testing over multiple visits, they could obtain a comprehensive picture in one sitting?
This isn’t wishful thinking anymore.
The NEURO TOUCH device has transformed neuropathy evaluation by integrating five essential tests into a single, streamlined examination.
Here’s why this matters for clinical practice.
The Complete Picture in Ten Minutes
- Traditional Biothesiometry:
The familiar vibration perception testing, but now with standardized protocols and digital documentation. No more subjective interpretations or lost results. - Hot and Cold Perception Testing:
This is where clinicians catch symptoms early. Thermal threshold testing identifies small fibre involvement before patients develop debilitating symptoms. It’s like having early warning radar for neuropathic pain. - Integrated Monofilament Testing:
The gold standard 10 g test, seamlessly incorporated rather than being an afterthought. No more separate equipment, no more forgetting to perform it during busy clinic days. - Skin Temperature Assessment:
Objective autonomic function evaluation that often reveals the first signs of impending complications. Temperature asymmetry between feet? That’s actionable clinical information.
- Traditional Biothesiometry:
Why This Changes Everything
Many clinicians initially express scepticism another device, another learning curve, another cost to justify. But those who’ve adopted integrated assessment report they can’t imagine returning to previous methods.
These are some advantages that make the NEURO TOUCH device a must have.
Time Efficiency: What used to require 30+ minutes across multiple procedures now takes under 10 minutes. That’s not just convenient; it’s practice-changing when seeing 40 patients daily.
Early Detection: Clinicians are identifying neuropathy at stages where patients can still benefit from aggressive intervention. This matters for outcomes and clinical confidence.
Patient Understanding: When physicians can show patients objective data across multiple nerve function domains, patients genuinely understand why foot care matters. Compliance improves dramatically.
Longitudinal Tracking: AI-powered reporting provides trend analysis that manual documentation simply can’t match. Clinicians can detect subtle changes over time that might otherwise be missed.
Putting It in to Practice: What Actually Works
Here’s how progressive clinics have integrated this approach:
Every diabetic patient receives the complete five-test battery annually, regardless of symptoms. No exceptions. This isn’t about being thorough for thoroughness’ sake; it’s about not missing asymptomatic patients who are already developing nerve damage.
Risk stratification drives follow-up:
Normal results across all five tests? Annual screening suffices. Abnormal thermal testing with normal vibration? Six-month follow-up with neuropathic pain management counselling. Abnormal monofilament? Immediate foot care education and protective footwear discussion.
The technology actually facilitates adoption:
The device is genuinely portable (clinicians use it for bedside assessments), connects seamlessly to EMR systems, and the battery lasts through full clinic days. These aren’t minor conveniences; they’re the difference between successful adoption and abandonment.
Conclusion
Healthcare providers will never prevent every diabetic complication. But they can give better care rather than missing early neuropathy just because testing approaches haven’t evolved with disease understanding.
The shift toward comprehensive assessment isn’t about abandoning established knowledge; it’s about completing the diagnostic picture. When clinicians combine vibration testing with thermal assessment, protective sensation evaluation, and autonomic monitoring, screening transforms from a routine checkbox into a powerful diagnostic and prognostic tool.
The Clinical Imperative
Patients don’t understand the difference between large fibre and small fibre testing, but they experience the difference when problems are caught early versus when clinicians are managing complications after they develop.
Comprehensive neuropathy evaluation isn’t about perfect technology or perfect protocols. It’s about giving healthcare providers the best possible opportunity to help patients avoid preventable complications.
And ultimately, that’s what defines quality healthcare: staying ahead of the disease rather than chasing it.
Making the Transition
For clinicians considering enhanced neuropathy assessment, the evidence is compelling.
Modern integrated devices like NEURO TOUCH don’t just add tests; they streamline workflows, improve diagnostic accuracy, and provide the comprehensive data needed for optimal patient care.
The question isn’t whether healthcare providers can afford to upgrade their neuropathy assessment approach; it’s whether they can afford not to, knowing what comprehensive evaluation can prevent.
Ready to experience comprehensive neuropathy assessment?
Healthcare professionals can contact Yostra Labs for a NEURO TOUCH demonstration to see how integrated evaluation enhances clinical outcomes. Because patients deserve the complete diagnostic picture.
References
[1] Hicks CW, Selvin E. Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Curr Diab Rep. 2019;19(10):86. Published 2019 Aug 27. doi:10.1007/s11892-019-1212-8
[2] Zhou P, Zhou JS, Li JJ, Qin L, Hu WF, Zhang XY, Wang JX, Shi Z. Prevalence and risk factors for painful diabetic peripheral neuropathy: a systematic review and meta-analysis. Front Neurol. 2025;16:1564867. doi:10.3389/fneur.2025.1564867
[3] Johnson SA, Shouman K, Shelly S, et al. Small Fiber Neuropathy Incidence, Prevalence, Longitudinal Impairments, and Disability. Neurology. 2021;97(22):e2236-e2247. doi:10.1212/WNL.0000000000012894
