How to Perform a Semmes Weinstein Neuropathy Skin Test for Peripheral Diabetic Neuropathy

The American Diabetes Association recommends that 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. This simple, inexpensive screening test should be performed at least once a year on our patients
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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 on the plantar surface of their feet are considered to have lost protective sensation.

The loss of skin protective sensation or peripheral neuropathy can lead to severe complications in diabetics. One of the most severe is a diabetic neuropathic plantar foot ulcer. An ulcer on the foot can lead to infection and amputation.

How to Perform a Semmes Weinstein Neuropathy Skin Test for Peripheral Neuropathy

1. Have the patient in a sitting position with shoes and socks off.
2. Explain to the patient that you’re screening/testing for neuropathy (loss of skin nerve feeling).
3. Touch the Semmes-Weinstein nylon monofilament wire to the patient’s arm to show what the touch feels like.
4. Tell the patient to respond “Yes” each time he or she feels the pressure of the 5.07 monofilament wire on the foot during the exam.
5. Tell the patient to shut their eyes during the exam.
6. Hold the monofilament wire 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. Avoid callused areas.
9. Record response on foot screening form with “+” for Yes and “–” for No.

Teri Green
Atlas Biomechanics