Which sites for monofilament testing

lisa farndon · Dec 6, 2005

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I would be very interested for colleagues' opinions on which sites to test with the 10g monofilament and the references for this. We are currently re-designing our diabetes assessment form and have some disagreement amongst some of our team regarding which sites to test, how many to test on each foot, and what criteria to use for flagging a neuropathic foot (2 or more sites absent on one foot seems to be the consensus at the moment), but I would be grateful for any research evidence to support this.

Tuckersm · Dec 6, 2005

Lisa,

we recently had one of our students redesign our diabetes assesment form based on current available evidence. Re cutaneous perception
Cutaneous Pressure Perception

The most common tool used is the Semmes-Weinstein 5.07 monofilament which generates a reproducible, quantifiable 10g pressure assesses light touch perception. The filament is applied perpendicular to the plantar skin surface with sufficient force to buckle the monofilament. The pressure is applied for approximately 1-2 seconds. If undetected the site may be re-tested up to five times to ensure an accurate result. (Rahman et al 2003, Miranda-Palma et al 2005)
Currently four sites are encouraged; apex of hallux, plantar metatarsal heads one, three and five. (Baker 2005, Boulton et al 2004)
A study conducted by Booth and Young, assessed the variability of different monofilaments. They assessed longevity and recovery times and discovered that each filament can be used on approximately 10 patients (using 5 testing sites per foot) before requiring a 24 hour recovery period between each patient. (Booth and Young, 2000)
Peripheral Neuropathy is the most common component cause of pedal ulceration in patients with diabetes, as it is present in approximately 78% of ulcer pathways. For this reason regular monitoring to establish the extent and severity of peripheral neuropathy through the use of the 5.07 Semmes-Weinstein Monofilament is essential. (Reiber et al 1999, Baker 2005, Boulton et al 2004, Booth and Young 2000, Rahman et al 2000)
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Craig Payne · Dec 6, 2005

Check this discussion:
http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=39

NewsBot · Feb 22, 2012

Dorsal versus ventral monofilament testing of the great toe for the identification of diabetic sensorimotor polyneuropathy.
Orszag A, Shin TM, Bril V, Perkins BA.
Diabetes Res Clin Pract. 2011 Aug;93(2):e71-3

We tested whether monofilament examination of the ventral rather than dorsal aspect of the great toe could better detect diabetic sensorimotor polyneuropathy (DSP). Although dorsal testing had better overall performance for identifying Subclinical DSP, the magnitude of benefit was small and there was no difference in identifying Clinical DSP.
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NewsBot · Jan 4, 2013

Pilot study on the significance of random intra-site placement of the Semmes-Weinstein monofilament.
Slater RA, Koren S, Ramot Y, Buchs A, Rapoport MJ.
Diabetes Metab Res Rev. 2013 Jan 3.

BACKGROUND:
The possible effect of random intra-site placement on the outcome of the Semmes-Weinstein monofilament (SWF) test is not known. We sought to determine the significance of this variable in the diagnosis of loss of protective sensation (LOPS) in patients with diabetes.

METHODS:
Forty-five patients with diabetes with history of pedal ulceration (Group 1), 81 patients with diabetes without history of ulceration (Group 2), and 21 non-diabetic controls (Group 3) were studied. The three original sites of the International Consensus on the Diabetic Foot (ICDF) at the hallux, 1(st) and 5(th) sub-metatarsal areas were divided into peripheral and interior zones resulting in a total of 6 zones.

RESULTS:
Mean total scores of SWF test and the resulting percentage of LOPS were significantly lower in peripheral zones as compared with interior zones of both feet in all three groups.

CONCLUSIONS:
Intra-site monofilament placement can significantly affect SWF test results and the diagnosis of LOPS. A model that corrects the effect of random intra-site placement is needed
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Which sites for monofilament testing

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Which sites for monofilament testing

lisa farndon Welcome New Poster

Tuckersm Well-Known Member

Craig Payne Moderator

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Advice on good web sites to advertise podiatry practices for sale.

A Retrospective Two Year Study of 199 Patients at 12 Clinical Sites, Following Treatment of Mycotic

Potential sites of compression of tibial nerve branches in foot

Amputation - support and general info sites

HPC regulation on Blogs & Networking sites

What are the most visited Podiatry Websites

Grinding orthotics made from carbon graphite composites

Share This Page

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