The Diabetic Foot

Monofilament Test

Peripheral neuropathy (PN), or nerve damage of the extremities, is one of the most common complications of diabetes (60 percent of all people with the disease develop it at some point). Symptoms include burning, tingling, numbness, a prickly sensation (like “pins and needles”), and muscle weakness. Neuropathy is the result of chronically high blood sugars, so the best way to prevent it is to maintain good glucose control. To check for neuropathy, your doctor should perform a monofilament test a measure of the sensation in your feet at least annually. In this simple yet sensitive evaluation, the monofilament, which is a piece of plastic fiber resembling fishing line, is touched against various parts of the sole of your foot, and your ability to feel it at varying pressure is assessed. It is sometimes called the l0 gram monofilament test because the fiber is calibrated to bend to 10 grams of pressure. Your doctor may also use a tuning fork on the bottoms of your feet to see if you can sense the vibration. Nerve conduction studies or velocity tests, which use electrodes to stimulate nerves and then measure the resulting impulses, are a less frequently used, more sophisticated method of diagnosing some neuropathies. Electromyography (EMG), which uses thin needles inserted into the muscles to measure electrical impulses, may also be prescribed. These latter two tests can be painful, and may not be ordered unless there is some question about the diagnosis.

When To See A Podiatrist

For people with neuropathy, the ADA recommends a thorough foot exam at least annually and a visual inspection of the feet at each regular physician’s appointment. Your regular doctor may perform these tests, or she may refer you to a podiatrist. A doctor of podiatric medicine COPM) is a medical doctor with specialized training in the physiology and medical care of the foot and ankle. Podiatrists are licensed in all fifty states. If you have diagnosed structural, nerve, or skin problems with your feet, a podiatrist should be on your diabetes care team, and you should see him every three to six months. Foot ulcers, in particular, require specialized wound care to avoid infection and possible amputation. In addition to the regular tests for neuropathy described previously, a podiatrist will assess the pulse and blood pressure of the foot and ankle and the temperature of your feet to screen for circulatory problems. Ultrasound or Doppler may be used to check blood flow.

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