What type of monofilament is used to assess diabetic neuropathy?

From the Guidelines

The 10-g monofilament is the standard tool used for diabetic neuropathy screening, as recommended by the most recent guidelines 1. This specific monofilament exerts exactly 10 grams of force when bent against the skin, providing a consistent stimulus to test protective sensation in diabetic patients. To perform the test, the monofilament is applied perpendicular to the skin surface until it bends slightly, held for about 1-2 seconds, and then removed. Testing is typically done at specific sites on the foot including the plantar surface of the great toe, the base of the first, third, and fifth metatarsals, and the heel. Inability to feel the monofilament at one or more sites indicates loss of protective sensation, suggesting peripheral neuropathy. Some key points to consider when using the 10-g monofilament include:

• It is a simple, non-invasive test that is crucial for early detection of sensory loss in diabetic patients, allowing for timely intervention to prevent foot ulcers and potential amputations.
• Regular screening with the 10-gram monofilament is recommended as part of routine foot examinations for all diabetic patients, as stated in the guidelines 1.
• The test should be performed with at least one other neurologic assessment tool, such as pinprick, temperature perception, ankle reflexes, or vibratory perception with a 128-Hz tuning fork or similar device, to confirm the presence of loss of protective sensation (LOPS) 1. Overall, the 10-g monofilament is a valuable tool for assessing diabetic neuropathy and preventing related complications, and its use is supported by the latest evidence and guidelines 1.

From the Research

Monofilament Used for Diabetic Neuropathy

• The 10 g Semmes-Weinstein monofilament is commonly used for screening diabetic peripheral neuropathy 2, 3, 4, 5, 6
• The 10 g monofilament test is recommended for distal symmetric polyneuropathy screening and diagnosis 2
• The test can be performed on 3,4, or 10 sites per foot, with similar effectiveness for diabetic peripheral neuropathy screening 2
• The 10 g monofilament is useful for detecting severe neuropathy and identifying patients at increased risk of ulceration and amputation 5

Comparison with Other Tests

• The clanging tuning fork test is a novel method for using the C 128-Hz tuning fork to test for diabetic peripheral neuropathy, and it provides a quantitative assessment of DPN 4
• The vibration perception test can identify more patients at risk of foot complications than the monofilament test 6
• The tuning fork test can also identify more patients at risk of foot complications than the monofilament test 6

Limitations of the 10 g Monofilament

• The 10 g monofilament has limitations, including the need for a consensus on the protocol for its use and further research on the effects of environmental conditions on its accuracy 5
• The monofilament test may not detect all patients at risk of foot complications, and other tests such as the vibration perception test may be more sensitive 6