2,46 Mb - GuÃaSalud
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Appendix 8. Use of monofilament<br />
Monofilament 5.07<br />
It assesses the sensitivity to pressure and touch, which is known as «protective<br />
sensitivity».<br />
It consists of a nylon filament attached to a handle, which applies a constant<br />
10g pressure when bent, regardless of the force which the examiner uses.<br />
Rules to use the monofilament (MF)<br />
• The monofilament is applied perpendicular to the patient’s skin and the pressure is increased<br />
gradually until the MF is bent. It is at this stage when the assessment takes place.<br />
• It must not be applied more than 1-2 seconds.<br />
The screening is carried out on four plantar points in each<br />
foot: first toe (distal phalanx), base of the first, third and fifth<br />
metatarsal.<br />
(Note: In the case of hyperkeratosis, the monofi lament will<br />
be applied in the perimeter area or the screening will be repeated<br />
once the callus has been removed).<br />
• Each of the locations will be rated 1 or 0, depending on<br />
if the patient feels the pressure or not. The total amount<br />
of these values will give the sensitivity index to the MF<br />
(from 0 to 8).<br />
• A patient is considered sensitive only when the result is<br />
8/8.<br />
Cautions to be considered when using the monofilament<br />
1. Make sure the patient knows what to expect: Apply the MF in a different area and<br />
which he can identify easily (upper extremities, face, etc.) so that he can get an idea of<br />
the type of sensation.<br />
2. During the screening: The patient will close his eyes and will be told: “Now I am going<br />
to put this device in different points in your feet: please let me know when you feel it<br />
and try to tell me where you feel it: in which foot, in which toe, in which sole....” When<br />
the MF is applied, avoid the following question: do you feel it now? Do ask the question<br />
at some point when the monofilament is not applying any pressure.<br />
3. Those patients with some insensitive point will have the test repeated in those same<br />
points once the first screening is finished (repeated screening in two stages). If the patient<br />
is sensitive in the second screening, this point will be considered sensitive.<br />
In those patients who show sensitivity in all sensitive points (MF index = 8), there is no need<br />
to repeat the test.<br />
CLINICAL PRACTICE GUIDELINE ON TYPE 2 DIABETES 147
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