A comprehensive screening assessment for peripheral nerve function and vascular health in patients with diabetes, designed to detect early changes before symptoms develop.
Peripheral neuropathy and peripheral arterial disease are among the most common complications of diabetes. They develop gradually and silently over years. By the time a patient notices symptoms such as numbness, burning, or a wound that is slow to heal, the underlying changes have typically been present for a considerable period. Annual screening is the only reliable way to detect these changes early, when intervention is most effective.
This assessment is designed for patients at all stages of diabetes, including those with no current symptoms. It is not a treatment for an existing problem. It is a structured, objective screening process that builds a detailed picture of peripheral nerve function, arterial circulation, thermal patterns, pressure distribution, and protective sensation. Findings are compiled into a single structured report reviewed with you by the physician or clinical nurse at the end of the session.
The full assessment takes approximately 45 to 60 minutes.
Component 1: Ankle Brachial Pressure Index (ABPI) Doppler
The Ankle Brachial Pressure Index is a validated and widely used measure of peripheral arterial health. Doppler ultrasound is used to record arterial waveforms and systolic blood pressure at the brachial artery in the arm and at the posterior tibial and dorsalis pedis arteries at the ankle. The ratio of ankle pressure to brachial pressure (the ABPI) is then calculated for each limb.
A normal ABPI is between 0.91 and 1.30. Values below 0.90 indicate peripheral arterial disease, with lower values corresponding to greater severity of arterial compromise. Values above 1.30 may indicate arterial calcification, which is itself a marker of cardiovascular risk, and warrants further investigation. The arterial waveform pattern provides additional qualitative information about vessel wall compliance and the quality of distal blood flow that the pressure ratio alone does not capture.
ABPI Doppler assessment is also performed as a standalone investigation when clinically indicated. Indications include suspected peripheral arterial disease, claudication symptoms, non-healing wounds or ulcers, pre-procedural assessment, and cardiovascular risk evaluation in high-risk patients. If your physician has referred you specifically for a Doppler study, only this component will be performed unless the full screening assessment has been requested.
Component 2: Digital Biothesiometry and Vibration Perception Threshold
A biothesiometer delivers a measured vibration stimulus at multiple standardised points on the sole of each foot. The threshold at which you first detect the vibration is recorded in volts. Results are graded as follows: 0 to 15 volts is normal, 16 to 20 volts indicates mild loss of vibratory perception, 21 to 25 volts indicates moderate loss, and above 25 volts indicates severe loss of vibratory perception. Vibration perception threshold testing is one of the most sensitive available markers of early peripheral neuropathy and is capable of detecting nerve fibre changes before they become clinically apparent on standard examination.
Component 3: Monofilament 10g Study
A standardised 10-gram Semmes-Weinstein monofilament is applied at multiple mapped points across the plantar surface of each foot. You will be asked to indicate whether you can feel the pressure at each point without looking. Loss of sensation at any mapped point indicates loss of protective sensation, which is a significant independent risk factor for plantar ulceration. Results are recorded as present, absent, or not recorded at each anatomical site and compared bilaterally.
Component 4: Plantar Pressure Mapping
You will be asked to stand and walk on a pressure-sensitive platform that records the distribution of weight across the entire plantar surface of each foot. The output is a colour-coded pressure map showing zones from very high pressure to reduced contact. Areas of concentrated pressure correspond to bony prominences or structural changes in foot architecture that create focal stress. These are the most common sites for callus formation and ulceration in patients with diabetes.
Where plantar pressure mapping identifies zones of significantly elevated pressure, offloading through specialised therapeutic footwear or custom orthotic insoles may be recommended. Pressure offloading redistributes weight away from high-risk zones, reducing the mechanical stress that drives callus formation and tissue breakdown. Your physician will advise you on whether a referral for footwear assessment or orthotic prescription is appropriate based on your pressure map findings.
Component 5: Plantar Thermal Monitoring
Infrared thermometry is used to record skin surface temperature at seven standardised points on each foot: the great toe, first, third, and fifth metatarsal heads, instep, heel, and dorsum. The measurement is non-contact and takes only a few minutes. The left-to-right temperature difference at each point is then calculated.
A temperature asymmetry greater than 4 degrees Fahrenheit (2.2 degrees Celsius) between the corresponding points on the two feet is considered a clinically significant finding. This level of asymmetry indicates localised inflammation in that zone, which is a recognised precursor to tissue breakdown and ulceration even in the absence of any visible skin change or reported symptom. Thermal monitoring therefore identifies at-risk zones at a stage when protective measures can still prevent progression.
All components are compiled into a single structured report. The findings are reviewed with you by the physician or clinical nurse at the end of your appointment. Depending on the results, recommendations may include optimisation of your diabetes management plan, a referral for therapeutic footwear or orthotic assessment, a referral to a vascular surgeon or specialist, or a more frequent reassessment schedule. Annual screening is recommended for all patients with diabetes. Patients with identified abnormalities are typically reassessed every three to six months.
No component of this assessment is painful. The Doppler uses a handheld probe with gel applied to the skin, similar to a standard ultrasound. The biothesiometer delivers a vibration stimulus that is not painful. The monofilament involves a gentle pressure against the skin. The plantar pressure mapping requires only that you stand and walk normally on the platform.
Yes. This is precisely the purpose of annual screening. Peripheral neuropathy and peripheral arterial disease in diabetes frequently develop without noticeable symptoms in their early stages. By the time symptoms appear, the opportunity for early intervention has already passed. The assessment is most valuable when it detects risk before symptoms develop.
The Ankle Brachial Pressure Index is the ratio of blood pressure measured at the ankle to blood pressure measured at the arm. It is a well-validated measure of peripheral arterial health. A low ABPI indicates that the arteries supplying the lower limbs are narrowed or diseased, which reduces blood flow to the feet and significantly impairs the ability of wounds to heal. Detecting a reduced ABPI early allows treatment and risk factor modification to begin before complications arise.
Yes. ABPI Doppler assessment is available as a standalone investigation when specifically indicated. If your physician has referred you for a Doppler study for a particular clinical reason, only that component will be performed. The full four-component assessment is recommended for annual diabetes screening.
The complete assessment takes approximately 45 to 60 minutes, including the time for reviewing and discussing the findings with you at the end of the session.
No. There is no fasting requirement for this assessment. You can eat and drink normally before your appointment.
A brief foot check during a routine consultation typically involves a visual inspection and possibly a monofilament test at a limited number of points. This assessment uses four dedicated instruments to quantify arterial pressure and waveforms, vibration perception threshold, protective sensation, and plantar pressure distribution across multiple standardised anatomical points. It produces an objective, documented, and reproducible dataset that a clinical foot inspection cannot provide.
The plantar pressure map shows the distribution of weight across the sole of your foot during standing and walking, displayed as a colour-coded image. Areas of very high pressure identify sites that are at elevated risk of callus formation and ulceration. Where significant pressure concentrations are found, your physician may recommend a referral for specialised therapeutic footwear or custom orthotic insoles designed to redistribute weight away from those zones and reduce the risk of tissue breakdown.
Infrared thermometry is used to measure skin surface temperature at seven points on each foot without any contact with the skin. The temperatures on the left and right foot are compared at each corresponding point. A significant difference in temperature between the two feet at any point indicates localised inflammation in that area, which is a known early warning sign of tissue stress and potential ulceration. The scan takes only a few minutes and is entirely painless.
Annual assessment is recommended for all patients with diabetes. If any component identifies an abnormal finding, your physician will recommend a more frequent schedule, typically every three to six months, to monitor for progression or improvement.
Our clinic team will guide you through the process from booking to results.
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