Posts Tagged ‘Monofilament Testing’

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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