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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.
we recently had one of our students redesign our diabetes assesment form based on current available evidence. Re cutaneous perception
Cutaneous Pressure Perception
Quote:
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)
__________________ Stephen Tucker Eastern Health
Podiatry Manager
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Which sites for monofilament testing
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