Intact Monofilament Sensation: Clinical Implications and Management
This patient has intact protective sensation bilaterally, indicating they are NOT currently at high risk for diabetic foot ulceration, but they still require annual screening and basic preventive foot care education. 1
Interpretation of Results
Protective sensation is present when the patient correctly identifies monofilament application at each tested site, which this patient has demonstrated across all 9 sites on both feet 2
Intact sensation across all tested sites indicates the absence of loss of protective sensation (LOPS), which is the primary risk factor for diabetic foot ulceration that monofilament testing is designed to detect 1
This result suggests the patient does not have clinically significant distal sensorimotor polyneuropathy affecting protective sensation at this time 1
Recommended Management
Ongoing Surveillance
Continue annual monofilament screening to identify any future development of neuropathy, as recommended for all patients with diabetes 1
Be aware that monofilaments can lose their buckling force with extended use, which may affect test reliability in future examinations 2
Patient Education
Educate the patient on basic foot care principles including daily foot inspection, proper nail care, and appropriate footwear 2
Instruct the patient not to walk barefoot, in socks only, or in thin-soled slippers to maintain foot protection 3
Emphasize the importance of maintaining optimal glycemic control to prevent future development of neuropathy 2
Level of Care
- This patient can be managed at Level 1 care (general practitioner, podiatrist, and diabetic nurse) as they do not currently have high-risk features requiring specialized multidisciplinary foot care 2
Important Clinical Caveats
While this patient has intact sensation now, neuropathy can develop over time, particularly with longer diabetes duration and suboptimal glycemic control 4
The monofilament test specifically assesses large fiber function and protective sensation; it does not evaluate small fiber neuropathy (pain, temperature) which may be present even with normal monofilament testing 1
Ensure proper testing technique was used: perpendicular application with sufficient force to buckle the filament, 2-second contact duration, and correct scoring (2 out of 3 correct responses per site) 2
The patient should not see where the monofilament is being applied during testing to ensure validity of results 2