{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:09:45Z","timestamp":1777856985644,"version":"3.51.4"},"reference-count":23,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2020,1,8]],"date-time":"2020-01-08T00:00:00Z","timestamp":1578441600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neuromuscular Diseases"],"published-print":{"date-parts":[[2020,1,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Neuropathic feet are at very high risk for infection and amputation. The slipping slipper sign (SSS) is elicited by a simple questionnaire test reported to detect the presence of severe diabetic peripheral neuropathy. This test can be administered by non-medical staff. In this study, subjects with and without the SSS were evaluated by nerve conduction studies (NCS) and ultrasound measurements of the right sural nerve diameters as well as with traditional scoring systems for peripheral and autonomic neuropathy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To demonstrate that the Slipping Slipper Sign can be used as an index of severe diabetic peripheral neuropathy<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>This was a prospective cross sectional study in which 74 patients with diabetes (38 positive and 36 negative for SSS) underwent ultrasonography and NCS of the right sural nerve by an examiner blinded to SSS status. Findings were evaluated against demography, clinical history, anthropometry as well as traditional clinical and autonomic neuropathic scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Patients without the SSS [median (IQR)\u200a=\u200a10.0 years (4.0\u201320.3)] had a significantly shorter duration of diabetes compared with those with the SSS [median (IQR)\u200a=\u200a15.0 years (8.5\u201325.0)], p\u200a=\u200a0.028. The frequencies of retinopathy (36.8% vs 2.8%, p\u200a&lt; \u200a0.05) and cerebrovascular accidents (18.4% vs 13.9 %, p\u200a&lt; \u200a0.05) were higher among those with SSS compared with those without. Differences in nerve conduction characteristics were markedly significant. The amplitude of the sural sensory nerve action potential (SNAP) was ([median (IQR)] 0 microvolts vs 4.0 microvolts (0.0\u201310.8) p\u200a&lt; \u200a0.002) between those with and without SSS, respectively whilst none of patients with SSS had a recordable SNAP vs 78% without a SSS. Similarly, maximal thickness of the right sural nerve at the ankle 3.0\u200amm (2.3\u20133.4) vs 3.5\u200amm (3.0\u20133.9), and leg 3.4\u200amm (2.7\u20133.8) vs 3.9\u200amm (3.3\u20134.2) was reduced, p\u200a&lt; \u200a0.01 in patients with the SSS compared with those with a negative SSS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The SSS identifies feet with objective neurophysiological and imaging characteristics of severe neuropathy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3233\/jnd-190422","type":"journal-article","created":{"date-parts":[[2020,1,10]],"date-time":"2020-01-10T11:41:04Z","timestamp":1578656464000},"page":"175-181","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Slipping Slipper Sign: A Poor Man\u2019s Test for Severe Diabetic Peripheral Neuropathy"],"prefix":"10.1177","volume":"7","author":[{"given":"Khama","family":"Lutchmansingh","sequence":"first","affiliation":[{"name":"Department of Clinical Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y. Swamy","family":"Venkatesh","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of South Carolina School of Medicine, SC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leela Krishna Teja","family":"Boppana","sequence":"additional","affiliation":[{"name":"Department of Clinical Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terence","family":"Seemungal","sequence":"additional","affiliation":[{"name":"Department of Clinical Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ambika","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, William Jennings Bryan Dorn VA Medical Center, SC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sherry","family":"Sandy","sequence":"additional","affiliation":[{"name":"Department of Clinical Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Surujpal","family":"Teelucksingh","sequence":"additional","affiliation":[{"name":"Department of Clinical Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,1,8]]},"reference":[{"key":"ref001","doi-asserted-by":"publisher","DOI":"10.2337\/dc17-0179"},{"key":"ref002","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8227(01)00343-6"},{"key":"ref003","doi-asserted-by":"crossref","unstructured":"GarciaJM, VelaseoPP, CabrerizoL, Pe\u2019rezM and GomezVL. Prevalence of distal diabetic polyneuropathy using quantitative sensory methods in a population with diabetes of more than 10 years\u2019 disease duration. 2010;57(9):414\u201320.","DOI":"10.1016\/j.endonu.2010.05.006"},{"key":"ref004","doi-asserted-by":"publisher","DOI":"10.1111\/jdi.12223"},{"key":"ref005","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001714"},{"key":"ref006","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2008.075234"},{"key":"ref007","unstructured":"International Diabetes Federation North America and Caribbean Region. IDF. [Homepage on the Internet]. Brussels, Belgium: International Diabetes Federation; 2014 [Cited 2019 June 19]. Available from: www.idf.org\/."},{"key":"ref008","unstructured":"Slipper. Merriam-Webster [Homepage on the Internet]. Massachusetts: Merriam Webster Dictionary; [Cited 2019 June 19]. Available from: www.Merriam-Webster.com\/."},{"key":"ref009","first-page":"48","volume":"18","author":"Gayle KAT","year":"2012","journal-title":"Clinics and practice"},{"key":"ref010","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.53.8.1660"},{"key":"ref011","doi-asserted-by":"publisher","DOI":"10.1017\/S0317167100040671"},{"key":"ref012","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2010.29.5.697"},{"key":"ref013","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0032730"},{"key":"ref014","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-0739"},{"key":"ref015","doi-asserted-by":"publisher","DOI":"10.1038\/ejcn.2009.139"},{"key":"ref016","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-1452"},{"key":"ref017","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182120147"},{"key":"ref018","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.25.11.2048"},{"key":"ref019","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.24.2.250"},{"key":"ref020","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.17.6.557"},{"key":"ref021","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.12.1.24"},{"key":"ref022","doi-asserted-by":"publisher","DOI":"10.1136\/postgradmedj-2015-133640"},{"key":"ref023","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(99)00170-5"}],"container-title":["Journal of Neuromuscular Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.3233\/JND-190422","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.3233\/JND-190422","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.3233\/JND-190422","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T23:49:25Z","timestamp":1777506565000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.3233\/JND-190422"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,8]]},"references-count":23,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2020,1,8]]}},"alternative-id":["10.3233\/JND-190422"],"URL":"https:\/\/doi.org\/10.3233\/jnd-190422","relation":{},"ISSN":["2214-3599","2214-3602"],"issn-type":[{"value":"2214-3599","type":"print"},{"value":"2214-3602","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,8]]}}}