Many of you probably wonder what in the world your podiatrist, family physician, or endocrinologist is doing when they touch you with a little plastic string and ask if you can feel it when your eyes are closed. Although it can seem like a cheap object found in a toy vending machine, the device is actually a sensitive instrument for diagnosing early neuropathy.
Called the Semmes-Weinstein monofilament, this nylon ‘string’ is specifically calibrated in stiffness to represent a baseline level of sensation that can be considered ‘the line’ between having neuropathy and having normal sensation. When it is placed against the foot and slightly bent due to the pressure of pushing it onto the foot, a person with normal sensation should feel it. If it’s pressure is not felt in at least four out of ten predefined areas, then it is reasonable to assume that diabetic neuropathy is present, and extra precautions need to be practiced to protect the foot from poor sensation.
There are other methods of testing for neuropathy, and the monofilament test should never be used alone to determine if neuropathy is present in a diabetic who has never had neuropathy before. However, this small plastic string can often be the simple difference in starting the protective process that can keep a diabetic from developing foot wounds and ultimately an amputation. Your podiatrist is likely always using this instrument. If your family doctor, internist, or endocrinologist is not, ask if they can add this relatively inexpensive instrument to their arsenal to test your feet on every visit.
Until next time,
Scott R. Kilberg DPM
www.inpodiatrygroup.com
myachingfoot.blogspot.com
thevideofootdoc YouTube channel
A foot doctor serving the communities of Indianapolis, Noblesville, Fishers, Carmel, Westfield, and Fortville Indiana.
2 comments:
What is the result if you test a patient with peripheral neuropathy having the complaints of numbness, tingling, pain and testing with the monofilament produces a "hypersensitivity" or over-response would this be considered still "normal" in the sense that they "feel" the monofilament?
Yes, this test does not distinguish between normal sensation and hyper-sensation (which is not really testable anyway), so the result will still be normal.
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