How to do a Semmes Weinstein monofilament exam

By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS

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Description

According to the American Diabetes Association, all patients with diabetes should be screened for loss of protective sensation in their feet (peripheral neuropathy) when they are diagnosed and at least annually thereafter, using simple clinical tests such as the Semmes-Weinstein monofilament exam.
The Semmes-Weinstein 5.07 monofilament nylon wire exerts 10 g of force when bowed into a C shape against the skin for 1 second. Patients who can’t reliably detect application of the 5.07, 10-g monofilament to designated sites on the plantar surface of their feet are considered to have lost protective sensation.

Steps

1. Place the patient in supine or sitting position with shoes and socks removed.
2. Tell the patient that you’re testing for loss of protective sensation, which increases the risk of foot ulcers and amputation.
3. Touch the 5.07 monofilament wire to the patient’s skin on the arm or hand to demonstrate what the touch feels like.
4. Instruct the patient to respond “Yes” each time he or she feels the pressure of the monofilament on the foot during the exam.
5. Instruct the patient to close his or her eyes and keep toes pointing straight up during the exam.
6. Hold the monofilament perpendicular to the patient’s foot. Press it against the foot, increasing the pressure until the monofilament bends into a C shape. (The patient should sense the monofilament by the time it bows.)
7. Hold the monofilament in place for about 1 second. Press the monofilament to the skin so it buckles at one of two times as you say “Time one” or “Time two.” Have the patient identify at which time he or she was touched. Randomize the sequence of applying the filament throughout the examination.
8. Locations for testing: On both feet, use the first, third, and fifth metatarsal heads and plantar surface of the distal hallux and third toe (see diagram). Avoid callused areas.
9. Record response on foot screening form with “+” for Yes and “–” for No.

Tip

Neuropathy usually starts in the first and third toes and progresses to the first and third metatarsal heads. It’s likely that these areas will be the first to have negative results with the Semmes-Weinstein monofilament exam.

Nancy Morgan, cofounder of the Wound Care Education Institute, combines her expertise as a Certified Wound Care Nurse with an extensive background in wound care education and program development as a nurse entrepreneur. Read her blog “Wound Care Swagger.”

Information in Apple Bites is courtesy of the Wound Care Education Institute (WCEI), copyright 2013.

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8 thoughts on “How to do a Semmes Weinstein monofilament exam”

  1. 258cinnamongirl says:

    Good information…thank you!

  2. Yolanda says:

    Hello,
    Is it possible you can tell me where to see a biography an full name of Semmes~Weinstein
    .
    Thanks a lot

    Yolanda Murad
    RN, BSN, ET, MSN

    1. Laura Knight says:

      Here is where you can learn about the creation of the WEST and Dr. Sidney Weinstein: http://www.timelyneuropathytesting.com/weinstein_tribute.htm

      Here is where you can buy the WEST from the creators of it: http://west-hand.weebly.com/

  3. ljboyd says:

    Is santyl a good choice for debriding the calloused area around a diabetic ulcer, if the patient is not a candidate for mechanical or surgical debridement?

  4. Nancy Morgan says:

    Hi LJBOYD,

    Santyl is for debriding necrotic tissue-slough or eschar.

    If pt is in clinic setting we’ll see the calloused shaved down by the clinician, and they may have to do that several times. Along with offloading the site.

    Hope that helps.

    Nancy

  5. Jai says:

    Thanks a lot.really helpful

  6. Ray says:

    What’s the difference between a Semmes-Weinstein filament and a von Frey filament?

  7. teri Green says:

    Foot neuropathy does not get enough press. More doctors need to perform this easy exam.
    Thanks,
    Teri Green
    Atlas Biomechanics

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