Identifying Patients With Diabetes Mellitus Who Are at Risk for Lower-Extremity Complications: Use of Semmes-Weinstein Monofilaments

Michael J Mueller


Plantar ulcers and lower-extremity amputation are frequent, severe, and costly problems in patients with diabetes mellitus (DM).1 Although there are many risk factors for developing foot problems, peripheral neuropathy is an important factor that seems to predispose patients to plantar ulcers and amputation.2

Patients with DM and peripheral neuropathy typically show a gradual loss of sensation on the plantar surface of their feet in a stocking-glove pattern.2 They seem to reach a threshold of insensitivity that puts them at risk for developing unnoticed ulcers on the plantar surface of the foot. This threshold has been referred to as the level of “protective sensation.”3 Clinicians need a method of easily and reliably testing for protective sensation to identify patients who are at risk for foot problems. Identification of those patients may allow preventive intervention.