Monofilament Testing: The Unknown Pharmacy Service

As a pharmacist, you are probably aware of the importance of daily foot care for those with diabetes. As diabetes progresses, peripheral neuropathy can occur and may lead to foot ulcers, infections, and (worst case scenario) amputation. Many pharmacists are trained in diabetic foot care and can assist patients with the following services:

-Diabetic foot exam to check for proper structure and presence of ulcers, calluses or wounds

-Diabetic shoe fitting and insole placement

-Education on proper foot care

Another service that many pharmacists are unaware of is monofilament testing. This test uses a 10-gauge nylon monofilament (looks like a small metal rod) to screen for peripheral neuropathy and proper blood flow.

How to perform the test:

Step 1: Place the monofilament tip on the patient’s hand so they are aware of what they should feel.

Step 2: Have patient remove shoes and socks and place the blindfold around their eyes.

Step 3: Gently, in a smooth motion touch the patient’s foot with the monofilament in each of the sites circled below. The touch should last for 1-2 seconds and enough pressure should be applied to make the monofilament bend. DO NOT place the monofilament on an ulcer, wound, callus or scar! Have the patient tell you each time they feel a touch. If a touch is felt, put a (+) in that circle on the diagram below. If the touch is not felt, put a (-) in that circle.

Step 4: Explain to the patient that this test does not diagnose peripheral neuropathy, but it does strongly indicate risk for development. If a (-) was marked down for any circle, advise the patient to see their physician for a more comprehensive evaluation. For all patients, emphasize the importance of continued foot care and benefits of playing an active role in their diabetes management.

Currently, pharmacists are unable to bill for an individual monofilament test; however, it can be billed as an add-on service through some programs. You could also charge a small fee for the service. Another option would be to provide it as a free service in order to help boost diabetic shoe sales.

If you currently work at a pharmacy that is interested in starting this service, you may be eligible to receive 50 free monofilaments through the U.S. Department of Health and Human Services Program called the LEAP program. LEAP stands for Lower Extremity Amputation Prevention and can be accessed at www.hrsa.gov/leap.

Source: www.hrsa.gov/leap

-By Katie McDonald