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SCREENING FOR THE AT RISK DIABETIC FOOT
IN GENERAL PRACTICE
Guide to the use of Monofilaments for sensory testing on the foot

  1. Use the 10g monofilament to test sensation.
  2. The sites to be tested are indicated on the foot diagram below.
  3. Apply the filament perpendicular to the skin's surface ( see Diagram A).
  4. The approach, skin contact and departure of the monofilament should be approximately 1.5 seconds duration.
  5. Apply sufficient force to allow the filament to bend ( see Diagram B).
  6. Do not allow the filament to slide across the skin or make repetitive contact at the test site.
  7. Randomise the order and timing of successive tests (to reduce potential for patient guessing.)
  8. Ask the patient to respond "yes" when the filament is felt.
  9. Do not apply to an ulcer site, callous , scar or necrotic tissue.

Test areas circled    Diagram A
Monofilament applied without pressure
Diagram B
Monofilament with pressure applied
The circles represent the places on the foot to test with the monofilament    
     

Consider the patient's feet to be "at risk" if the patient cannot feel the 10gm monofilament at any of the sites marked

Additional risk factors:

  • Absent foot pulses or cold/poorly perfused feet.
  • Previous history of foot problems
  • Foot deformities or callous formation
  • Other medical problems which limit mobility

Action: Refer to appropriate specialists if:

  • There is an ulcer with infection/cellulitis
  • There is known neuropathy
  • Chiropody care is needed
  • Protective footwear is needed
  • Peripheral vascular disease is present

Where to obtain Monofilaments

Reference: Semmes Weinstein Monofilaments: A simple effective and inexpensive screening device for identifying diabetic patients at risk of foot ulceration. Kumar S, Fernando DJS, Veves A, Knowles EA, Young MJ, Boulton AJM. Diabetes Research and Clinical Practice 1991; 13:63068



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