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Hi all,

Commonly during a diabetes foot assessment I have found that people can be sensate to the 5.07 (10g) monofilament but have abnormal vibration sensation, that being >25 volts with the biothesiometer. Achillies reflexes are also commonly absent. From what I remember and recently read large nerve fibre are responsible for vibration sensation but also light touch sensation (i.e. monofilament).

Could anyone please shed any more light onto this topic and what advice is given to patients with the above neurological result?

I have been advising patients that they have loss off protective sensation due to abnormal vibration sensation. However, due to being sensate to the monofilament, patients are commonly tested via other health professionals who only use a 5.07 monofilament, are told that their protective sensation is intact!

Mick B

 

Mick,

Protective sensation has only been shown to be measurable and reproducable with a monofilament. With research showing an actual increased risk of ulceration when the filament is not detected at more than one site. While theoretically sound the Biothesiometer has not undergone quite the same rigour on its actual ability to detect an at risk foot in "the wild"