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

8 Degree Varus/Valgus Heel Wedge, Cork Rubber

Varus/Valgus Heel Wedges can be used for pronation or supination problems of the foot and ankle. Heel Wedges are designed to help align the calcaneus (heel) during ambulation to limit excessive pronation or supination. They improve foot function by stabilizing weak, rotating ankles.

The valgus heel wedge is useful for patients with early medial compartment osteo-arthritis provided it is used with an understanding of the indications and its limitations. Research shows that patients with early medial compartment osteo-arthritis of the knee were treated with lateral heel wedges and were followed for a period of 7 years and 5 months to 12 years. Those who were treated with valgus heel wedges and analgesics showed a significantly greater improvement in pain score than those treated with analgesics only.

Professional Grade Cork Rubber Heel Wedges
*Medical Grade Rubber Cork
*5 lifts bulk pack
*8 degree Inversion or Eversion
*Correct Pronation: Thicker Side Facing Inward (Heel Varus Wedge)

*Correct Supination: Thicker Side Facing Outward (Heel Valgus Wedge)
*Long lasting, Comfortable
*Made in the USA by Atlas Biomechanics

Sizes: Small 2" (5.1cm) width, Medium 2 1/2" (6.4cm) width, Large 3" (7.4cm) width

Made from Medical Grade Rubber Cork

Produced by us in the USA by Atlas Biomechanics.

Teri Green
Atlas Biomechanics

Steel Insole Plate for Treatment of a Morton’s Toe

A steel plate insole can be beneficial in treating a Morton’s Toe. When the second toe is longer than the big toe, it is called Morton’s Toe.  This is due to genetics, you are born with it. Most people will not have any issues when their second toe is longer.

When the second toe is longer than the big toe, that means that the second metatarsal is longer than the first metatarsal. This will cause under stress on the metatarsal toe joint and the forefoot. Some of the most common problems this can cause are Metatarsalgia, (ball-of-foot pain), Morton’s Neuroma, Metatarsal Stress Fractures, Plantar Fasciitis, Calluses, Bunion, Hammer, Claw and Mallet toes.

A steel insole is a stiff orthotic plate that will not allow motion in the forefoot. They are produced from thin steel with a felt top-cover. Some also call them steel shank. One places the steel insole plate in place of the shoe’s insole. Now with a spring steel insole plate, the Morton’s Toe and forefoot is in a neutral position not allowing an abnormal range of motion.

Teri Green

Atlas Biomechanics