Posts Tagged ‘Monofilament Testing’

Diabetic Wound Care: Monofilament Testing

Friday, March 11th, 2016

Detecting neuropathy in the diabetic foot is crucial for patient care, which is why the 10-step monofilament test is a must when it comes to injury and ulceration prevention.

Monofilament Testing

 

Healing patients and helping them get on the road to recovery are always at the top of any wound clinician’s list. We are always on alert and in constant assessment mode, looking for ways to prevent further complications or possible injury. So when a patient also happens to be diabetic, our assessment mode goes into overdrive.

One of the most common complications of diabetes is neuropathy, or nerve damage of the extremities. With sensory neuropathy, the patient loses protective sensation and the ability to feel pain and temperature changes. Without protective sensation, the diabetic patient is at an increased risk for foot injury or ulceration, and may not realize anything is amiss until there are serious complications.

Neuropathy Screening

This is why testing your diabetic patients for neuropathy is so important. In fact, the American Diabetes Association recommends that we screen diabetic patients for neuropathy annually, at minimum. Once we note any diminished sensation, we should check quarterly.

One way to assess protective sensation in the diabetic foot is to perform a Semmes Weinstein 10g Monofilament Test across designated sites on the foot.  The test uses a 5.07 monofilament that exerts 10 grams of force when bowed into a C-shape against the skin for one second.

 

Monofilament Diagrams

 

How to Perform the Semmes Weinstein 10g Monofilament Test

The test procedure is as follows:

  1. Use the 10gm monofilament to test sensation.
  2. Have patient close his or her eyes.
  3. Apply the filament perpendicular to the skin’s surface.
  4. Be aware that the approach, skin contact and departure of the monofilament should be approximately 1.5 seconds in duration.
  5. Apply sufficient force to allow the filament to bend. (Figure 1).
  6. Do not apply to an ulcer site or on a callous, scar, or necrotic tissue.
  7. Do not allow the filament to slide across the skin or make repetitive contact at the test site. Randomly change the order and timing of successive tests.
  8. Ask the patient to respond, “Yes,” when he or she feels the filament.
  9. Document response when felt, and test for sensation (Figure 2).
  10. Be aware that neuropathy usually starts in the first and third toes, and progresses to the first and third metatarsal heads. It is likely that these areas will be the first to have negative results with the 10gm monofilament. Repeated testing can demonstrate vividly to the patient the progression of the disease.

Record the results on the screening form, noting a “+” for sensation felt, and a “-” for no sensation felt. The patient is said to have an insensate foot if they fail on retesting at just one or more sites on either foot. Injury is much more likely to occur in these insensate areas and we must take protective measures. Provide patient education verbally and in writing, such as these materials from the American Diabetes Association, and be sure to do a good shoe fit assessment as part of your care plan.

Do you administer the Monofilament test?

Are you familiar with the Semmes Weinstein 10g Monofilament Test, and do you administer it on a regular basis to your diabetic patients? Has monofilament testing produced significant results in terms of prevention and assessment? We are interested to know about your experiences in diabetic foot testing, so please leave your comments below.

 

Free Download - Neuropathic Foot Exam Guide

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Really, How Important is that Monofilament Test?

Monday, January 26th, 2015

Neuropathy is one of the most common risk factors for lower extremity complications in our diabetic patients. With sensory neuropathy the patient has a loss of protective sensation that leads to a decrease in the ability for our diabetic patient to sense pain and temperature changes. This loss of protective sensation puts the patient at an increased risk for plantar foot injury. Unfortunately the patient may not feel the injury until significant complications have occurred.

The American Diabetes Association set up guidelines for us as healthcare professionals, these guidelines recommend screening in diabetic patients for neuropathy to check for loss of protective sensation on an annual basis, one way this can be done by doing the Semmes Weinstein Monofilament test. If the patient is found to have decreased sensation and is found to be at high risk the monofilament test should then be done quarterly.

The Semmes Weinstein 10g Monofilament is a test that checks for protective sensation in the diabetic foot.  It uses a 5.07 monofilament that exerts 10 grams of force when bowed into a C-shape against the skin for one second.  We don’t apply the filament directly to the ulcer site, callous, scar or necrotic tissue. Ask the patient to close their eyes during the exam and tell them to reply “yes” when the monofilament is felt, repeat without touching skin occasionally to be sure of patients response. Be sure to use random order on successive tests.

Areas to be tested include the dorsal midfoot, plantar aspect of the foot including pulp (fleshy mass on the distal plantar aspect) of the first, third, and fifth digits, the first, third and fifth metatarsal heads, the medial and lateral midfoot and at the calcaneus.  Record the results on the screening form, noting a “+” for sensation felt and a “-” for no sensation felt. The patient is said to have an “insensate foot” if they fail on retesting at just one or more sites on either foot.

Those patients who cannot feel the application of the monofilament to designated sites on the plantar surface of their feet have lost their “protective sensation”. Without this protective sensation the diabetic is now at increased for injury or ulceration. Neuropathy is usually noted in the first and third toes and then progresses to the first and third metatarsal heads.

Injury is much more likely to occur in the diabetic insensate foot at these areas and interventions must be implemented to protect the diabetic foot that is at risk for ulceration. Patient education and good “shoe fit assessment” will be part of our plan of care to protect the diabetic neuropathic patients foot.

 

Monofilament Testing

Monday, January 3rd, 2011

Monofilament Testing

Are you testing for Neuropathy with your patients? Peripheral neuropathy (PN), or nerve damage of the extremities, is one of the most common complications of diabetes. Symptoms include burning, tingling, numbness, a prickly sensation (like “pins and needles”), and muscle weakness. Neuropathy is the result of chronically high blood sugars, so the best way to prevent it is to maintain good glucose control. One way to test for neuropathy, is to perform a monofilament test to measure  sensation of the patient’s feet. The reason you want to do this type of testing is to determine whether or not the patient has lost sensation in various areas of the extremity or feet. Below is a diagram and instructions of how to perform a monofilament test.Monofilament Testing Diagram

1. Place patient in supine or sitting position with shoes and socks removed.
2. Touch the monofilament wire to patient’s skin on arm or hand to demonstrate what the
touch feels like.
3. Instruct patient to respond “yes” each time they feel the pressure of the monofilament on
their foot during the exam.
4. Instruct patient to close their eyes with toes pointing straight up during the exam.
5. Hold the monofilament perpendicular to the patient’s foot. (See diagram A)
6. Press it against the foot, increasing the pressure until the monofilament bends into a C-
shape. (See diagram B) Do not apply over ulcer, callus, scar, or necrotic tissue. Do not slide
monofilament over the skin.
7. Hold in place for about 1 second. Press the filament to the skin such that it buckles at one
of two times as you say “time one” or “time two.” Have patients identify at which time they were
touched. Randomize the sequence of applying the filament throughout the examination.
8. Locations for testing: dorsal midfoot, plantar aspect of foot including pulp of the first, third,
and fifth digits, the first, third and fifth metatarsal heads, the medial and lateral midfoot and
the calcaneus.(See diagram C)
9. Record response on foot screening form with “+” for yes and “-“ for no.
10. When the Monofilament is not felt, protective sensation is absent placing the person at
high risk for development of a neuropathic ulcer.

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