Patient thinks monofilaments are touching opposite foot

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Hi all - I'm looking for some advice please from my more experienced readers......

I assessed a 65 year old male with bilateral ball of foot pain, which shoots into his toes during gait. He has no significant medical hx or current rx. He started with these pain symptoms almost suddenly, three years ago.

Mechanically, he has pes planus and genu vara bilat, but he has never had foot or lower limb pain before.

However.........................

When performing the 10g monofilament tests (with his eyes closed) he states all locations correctly on his left foot. However, every location I touch on his right foot, is reported correctly by him in terms of location, but he remarks that he is feeling it on his left foot!

(Once his eyes are open, he can see the monofilament touching his right foot, and only then does he sense the touch to the right foot.)

He has been to two neurophysiologists since 2008 who report his nerve conductivity tests are normal. He has been to consultant physicians on five occasions over the past three years and has been told he has no signs (or serology confirmation) of diabetes mellitus.

He has also seen an orthopaedic surgeon (last month) who worked in tandem with another neurophysiologist who concluded he doesn't have tarsal tunnel syndrome, PN or post-tib dysfunction.

I look forward to any help!

Thanks

 

Re: Patient thinks monofilaments are touching opposite foot!!!

Gerstmann syndrome

 

I suggest an alternate forced choice technique when using monofilament nylon to determine extent of protective sensation. I would suggest reviewing the following: Holewski, J.J., Stess, R.M., Graf, P.M., and Grunfeld, C.: Aesthesiometry: quantification of cutaneous pressure sensation in diabetic peripheral neuropathy. Journal of Rehabilitation Research and Development. Vol 25:2, p 1-10, 1988

 

Thanks Richard,

I read the interesting piece you kindly referenced and found it discussed the general reliability of monofilament tests re protective sensation... I was -on this occasion- primarily concerned with this patient reporting sensation, but on the opposite limb to the test site.

Cheers

 

I realized your inquiry was pertaining into opposite limb reliability but felt that the "Alternative Forced Choice" method as was used in the paper on Semms Weinstein filaments might be applicable as well as to the reliability in the reponses you were receiving.

Regards,
Richard Stess, DPM
Chief, VAMC San Francisco Retired
President STS Company

 

Thanks for the input Richard - much appreciated.

Out of interest, when touching his right foot with fingertip, pen, tuning fork, after the monofil tests, he still considered each touch to be on his Left foot instead.

Thx. K

 

Out of curiosity did you ever not touch his right foot with the monofilament and he still gave you the response that he he felt it on the left foot when forced to give a response? I am assuming he was recubment and was unable to see you apply the monofilament. For example...."Do you feel it now (when not applying it)? Where ?