Discussion of the relationship between diabetes and peripheral neuropathy and loss of protective sensation. How to perform a monofilament sensory test to detect a loss of protective sensation Learn more at ProhealthcareProducts.com

1. Diabetes, Peripheral
Neuropathy & How to
Conduct a Diabetic Foot
Monofilament Test

2. What is Diabetes?
 Type II diabetes is a disease that occurs when
the level of glucose (blood sugar) in your
blood are too high
 Blood glucose is the body’s primary energy
source and comes primarily from the foods
you eat
 Your pancreas produces the hormone insulin
that helps move blood glucose into your cells
to be used as energy
 Type II diabetics do not produce enough
insulin, or their body organs and tissues are
resistant to its effect  glucose stays in the
blood and not enough reaches the cells

3. What are the Risk Factors for
Developing Type II Diabetes?
 Family history of diabetes
 Overweight or obese
 Physically inactive
 More common in people who are African
American, Hispanic/Latino, American Indian, Asian
American, Islanders
 Hypertensive
 Previous gestational diabetes
 Develop insulin resistance

4. What are the Disease Mechanisms
Caused by Type II Diabetes?
 Two underlying major pathological/disease
mechanisms caused by Type II diabetes can lead
to a multitude of health conditions and diseases
 Atherosclerosis - A type of cardiovascular disease
characterized by the progressive narrowing and
hardening of an artery due to the build up of
plaque
 Nerve Damage – A high concentration of glucose
in the blood damages nerves throughout the body,
and especially in the legs and feet

5. What Health Conditions/Diseases can
People with Diabetes Develop?
 Heart disease
 Stroke
 Eye disease
 Kidney disease
 Peripheral Neuropathy
 Sexual problems
 Bladder problems

6. What is Peripheral Neuropathy?
 Peripheral Neuropathy: A condition that causes damage to
peripheral nerves leading to altered sensation of the skin
 Tingling
 Numbness
 Pain
 Crawling sensation, and . . . .
 A loss of protective sensation (LOPS)

7. What is Protective Sensation?
 Skin has several proprioceptors that when stimulated send a message to
the brain  interpreted as pain, temperature (hot or cold), touch, pressure,
vibration, etc.
 A loss of protective sensation (LOPS) inhibits or prevents these nerve
transmissions so that a person cannot detect injury or compromise to the
skin (e.g., nick, cut, blister)

8. The Harmful Combination of Neuropathy
& Atherosclerosis
 Peripheral Neuropathy - a loss of protective sensation. If areas of skin on
your foot lose the ability to detect injury or compromise, then lesions to
your skin (nick, cut, abrasion) could go undetected
+
 Atherosclerosis – reduced and inadequate blood flow in the arteries and
arterioles that supply oxygen and nutrients to the foot, would make even
the slightest lesion to the skin prone infection and difficult to heal  lead
to an infection, ulceration, and possible amputation

9. Areas of Greatest Risk for Peripheral
Neuropathy & Infection/Ulceration
 Weight bearing pressure points on the plantar surface of the
feet (heel, heads of the metatarsal bones, distal phalanx of the
toes)
 Shoe pressure points on the top of the foot and toes,
especially when musculoskeletal conditions exist like claw toe
or hammer toe

10. The Diabetic Foot Myofilament Test/Screen
(Semmes-Weinstein Monofilament Test)
 A Diabetic Foot Myofilament Test is designed to assess if there is a loss
of protective sensation to the high-risk areas of the foot so that
intervention strategies can be taken to slow the progression of the
peripheral neuropathy and protect against neuropathy complications
 10-Site Approach
 Big toe, 3rd toe, and 5th toe
 Heads of 1st, 3rd, and 5th metatarsals
 Heel
 Medial & Lateral border of the foot
 Dorsal surface of the foot over 1st metatarsal bone

11. How to Conduct the Diabetic Foot
Monofilament Test
 Preparation for Conducting the Monofilament Test
1. Wash hands prior to administering the test.
2. Instruct the patient to remove their shoes and socks.
3. Position the patient sitting on a table with feet hanging over the end of the table.
4. Explain the test to the patient so they understand the “what” and “why” of the
monofilament test.
5. Demonstrate the test by applying the monofilament strand perpendicular to the
patient’s palm, finger, and/or arm in similar manner to which it will be conducted
when applied to the foot.
6. Instruct the patient to lie down and avoid watching the test as it is conducted, as it is a
sensory perception test without visual feedback.
7. Instruct the patient to respond with a verbal “yes” or signal with a “raised hand”
when they feel the monofilament strand being pressed against their foot

12. How to Conduct the Diabetic Foot
Monofilament Test cont. . . . .
 Conducting the Monofilament Test
1. Reference the Diabetic Neuropathy Monofilament Foot Screen for the sites where
the monofilament will be applied as part of the 10-site Monofilament Test.
Left Foot Right Foot

13. How to Conduct the Diabetic Foot
Monofilament Test cont. . . . .
 Conducting the Monofilament Test
2. Hold the monofilament device so it is perpendicular to the skin where the test will be
performed. Then follow these three sequential steps:
 Touch the skin with the monofilament strand
 Smoothly apply sufficient force to cause the strand to bend into a curve, and hold
that position for approximately ½ to 1 second
 Lift the monofilament strand away from the skin
Note: Monofilament test kits can be purchased
from ProHealthcareProducts.com

14. How to Conduct the Diabetic Foot
Monofilament Test cont. . . . .
 Conducting the Monofilament Test
3. Documentation: Place a “+” in the site circle(s) when the patient responds “yes”, and a
“--” in the site circle(s) if the patient does not respond to a test site.
NOTE: Download the Diabetic Neuropathy Monofilament Foot Screen form HERE.
4. Important:
 The pace of administering the testing – moving from site to site – should vary so
that the patient does not “anticipate” when the test is being conducted.
 Testing should move randomly from site to site so that a recognized and
anticipated pattern is not developed.
 If during the testing the patient does not respond to a specific site, continue to
the next site uninterrupted. At conclusion of the testing (all 10 sites), REPEAT the
test at the site(s) where the patient did not respond indicating that they felt the
monofilament. Document accordingly.
 The testing should always be conducted on both feet.

15. A Final Word About Peripheral Neuropathy – From
Annals of Internal Medicine
(ACP Diabetes Monthly (/Archives/2020/12/11)
 Peripheral Neuropathy Associated with Increased Mortality Risk, irrespective of
diabetes status
 “Patients with both diabetes and peripheral neuropathy had the highest risk of death
during the study’s 13-year follow-up, but the next highest rate was in patients with
peripheral neuropathy but no diabetes, followed by those with diabetes without peripheral
neuropathy.”
 “Our study contributes to the growing body of literature supporting the concept that
peripheral neuropathy is associated with substantial clinical sequelae . . . . And that
“prevalence of peripheral neuropathy among adults without diabetes is substantial and
that peripheral neuropathy may be an underrecognized risk factor for death.”
 “Monofilament testing at the foot is a quick clinical screen for decreased lower-extremity
sensation that likely is a result of sensory peripheral nerve decline.”