Abstract
Study design:Prospective healthy volunteer study for sensory thresholds.Objectives:The aim of this study was to test sensory thresholds at different sites of the foot to provide a reference for diagnosis and neurologic classification.Setting:A university hospital for the research and clinical practice of rehabilitation.Methods:Thirty healthy volunteers were recruited, and quantitative sensory testing was performed on three sites of the foot (medial malleolus (for the L4 dermatome), dorsum of the foot at the third metatarsal phalangeal joint (for the L5 dermatome) and lateral heel (for the S1 dermatome)). First, cold sense, warm sense, cold pain and hot pain were tested. Second, a monofilament tactility test was performed. Finally, a physical examination for sensation was performed.Results:All of the thresholds for the medial malleolus were significantly different from those for the dorsum of the foot at the third metatarsal phalangeal joint and lateral heel, whereas no significant difference existed between the values for the dorsum of the foot at the third metatarsal phalangeal joint and lateral heel.Conclusion:The sensory threshold of the human medial malleolus may be significantly different from those of adjacent sites of the foot. Thus, the results obtained from physical examination of sensory thresholds of the medial malleolus should be used modestly as a reference, but should not be used for diagnostic or classification purposes.
Highlights
During a neurologic examination, dermatome refers to the area of the skin innervated by the sensory axons within each segmental nerve
The threshold of Spinal Cord pressure for tactility at A was significantly higher than those at B and C (Po0.05), whereas no significant difference existed between B and C (P40.05)
At the time of this study, ISNCSCI-2011 had been used for neurological evaluation of SCI cases in our institute since 2012
Summary
Dermatome refers to the area of the skin innervated by the sensory axons within each segmental nerve. According to the International Standards for Neurological Classification of Spinal Cord Injury, which were revised in 2011 (ISNCSCI-2011),[1] the sensory level is determined by performing an examination of the key sensory points, each presenting 1 of the 28 dermatomes of the spinal nerves. Appreciation of light touch and prick pin sensation at each key point is separately scored. Among these key points, the medial malleolus is designated as the L4 dermatome, the dorsum of the foot at the third metatarsal phalangeal joint is designated as the L5 dermatome and the lateral heel (calcaneus) is designated as the S1 dermatome. As ISNCSCI-2011 was used in our clinical work, the score of L4 was frequently lower than those of L5 and S1, even in patients in whom these nerves were spared.
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