Individuals with diabetes who have an adequate vascular status, intact protective sensation, absence of structural abnormalities, i.e. bunions or toe deformities, and supple intact skin are considered to be at low risk for foot problems. At high risk for foot injury are individuals who lack protective sensation or have compromised circulation. Additional indicators of risk are structural changes, thick calluses, anhydrotic skin, hypertrophic, mycotic toenails, and previous ulceration. Those patients at high risk for foot problems need nail care every three months to keep mycotic toenails and thick calluses debrided, to assess for new injuries, and to continually review diabetic foot care instructions.
Protective sensation is evaluated by using the Semmes-Weinstein monofilaments. These nylon filaments are mounted on a holder and come in three thicknesses, identified by logarithmic markings of 4.17, 5.07, and 6.10. This type of filament was first used to measure insensitivity in patients experiencing the neuropathy of Hansen's disease (leprosy). The patient's hand is touched with the monofilament so he knows what to expect, then the examiner asks the patient to close his eyes. The monofilament is applied perpendicular to the plantar surface until lateral bending occurs at the rate of one-second touch, one-second hold, and one-second lift. The patient is asked to identify the area being touched. The 5.07 monofilament is most commonly used and bends at a stress of 10 grams. The perception of the 5.07 monofilament is associated with the presence of protective sensation. If the patient cannot feel the 5.07 monofilament, protective sensation is thought to be lost.
For information on ordering the Semmes-Weinstein monofilaments:
Sensory Testing Jackson Hines Diabetes Foot Clinic Filament Project
1815 Dallas Dr. Ste. 11A 500 East Woodrow Wilson Drive
Baton Rouge, La. 70806 Jackson, Miss. 39216
1-504-927-7923 1-601-982-2650
Fax: 1-504-926-9053
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