Test sensation on the great toe and 1st, 3rd and 5th metatarsal heads of each foot.
Normal test is when the patient feels the monofilament on all test sites.
How to perform a monofilament exam:
Press the 10 gram monofilament perpendicular to the skin to the point of bending.
Hold for one second and then release.
Demonstrate the technique on your hand and then the patient’s hand.
Have the patient close their eyes and acknowledge sensation of pressure with a “yes” response.
Test sites include the great toe and 1st, 3rd and 5th metatarsal heads of each foot.
An abnormal test results when the patient cannot feel any sensation on one or more of the monofilament test sites.
Confirm normal monofilament exam with Vibration Sensation Exam.
Approximately 10% of high risk patients can feel a monofilament but have lost vibratory sensation.
How to perform a vibration sensation exam:
Using a 128Hz (C-note) tuning fork, tap the open end of the fork with the ball of your palm.
Holding the tip like a pencil, apply the tip of the fork to the great toe on the tip or first joint.
Have the patient notify you when they feel the vibration stops. An abnormal response occurs when the patient loses vibratory sensation and the examiner still perceives it while holding the fork on the tip of either toe.