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Probing Our Feet

By David Mendosa


We can now use disposable probes, sometimes called monofilaments, to test our feet at home. They check for a lack of sensitivity, which can be a warning of diabetic peripheral neuropathy and its consequences. These probes don’t hurt, don’t require a prescription, and are quick and easy to use.

There’s no free lunch — but you paid for this

You might even consider them to be free. This is an unadvertised government benefit that you have already paid for with your tax dollars. If you know who to call, the U.S. government will send you the probes you need to test your feet at no additional cost beyond what you paid on April 15.

Two doctors, Josephine Semmes and Sidney Weinstein, in 1960 developed a sophisticated set of monofilaments or probes to check the degree of sensitivity in our feet. They assigned numbers to these probes ranging from 4.17 to 6.10. The 5.07 probe became the accepted medical standard to determine the minimum level of protective sensation in the foot. These probes bend with a force of 10 grams. That’s why they are called Semmes-Weinstein 5.07/10 gram monofilaments or just SW 5.07 probes.

But there have been two problems with them. The first is cost. The SW 5.07 probes that your primary care physician, endocrinologist, and podiatrist use cost hundreds of dollars. Now, however, we can get disposable probes that give identical results.

The other problem is that those of us with diabetes haven’t been able to get our feet tested often enough. Until now, we needed an appointment with our doctor, who would test our feet — if he or she remembered.

Just press one of these nylon probes against different areas of your feet until you feel the probe buckle. If you can ask someone to do it for you, all the better.

There are five standard areas of each foot to test. These are the big and fourth toes and three areas of the ball of the foot — the inside, outside, and center.

If you can’t feel the probe, it means that you are at risk for ulceration and need special care. That means making an appointment with your doctor as soon as possible.

We owe these free disposable probes to the U.S. Bureau of Primary Health Care’s Lower Extremity Amputation Prevention Program, appropriately abbreviated as the LEAP Program. People at the Gillis W. Long Hansen’s Disease Center — which became known simply as “Carville” — saw that patients with Hansen’s disease (formerly known as leprosy) needed low cost and high quality probes. After their engineers figured out how to develop them, the LEAP program made them available to an even larger group who especially need to protect their feet — ; people with diabetes.

For months these probes or monofilaments haven’t been available, but at presstime are back in stock at the Bureau of Primary Health Care. You can get what they call a package of “LEAP Monofilaments” simply by calling the HRSA Information Center at 1 (888) 275-4772 (press 1 when offered the choice) or on the Web at http://www.ask.hrsa.gov/detail.cfm?PubID=PC00586. When you need more, they say to just call them again.

While you are at it, it can be quite useful to make another call for a related government freebie. You can order a copy of the booklet, “Feet Can Last a Lifetime,” by calling the National Diabetes Information Clearinghouse at 1 (800) 860-8747. This booklet, of about 50 pages, shows where, why, and how to test your feet.

These free probes and booklet are worth the time that it takes to make two telephone calls to toll-free numbers. That is their total cost, and of course, there is no free lunch. Just remember that you have already paid for this one. ”

    Update

    Please also consider this comment that I received December 8, 2008:

    The 10-gram disposbiles monofilaments are not quite equivalent to the CT-Bio 10g Softip(tm) monofilaments. The difference is sharpness, which may mean a great deal to someone with diabetes. Keeping it too brief, the ability to sense sharpness is just about the last tactile sensation to go in the diabetic foot. While one still has the ability to sense sharpness, one would not, for example, be able to detect repetititve rubbing that would (1) cause touch insensitivity to be lost and eventually (2) a lesion to be formed. The Softip monofilaments tend not to stimulate the sharp receptors, and, hence, when you don't sense their stimlation, you are in trouble. It's an early detection system, while still using 10-g force as a measure.

    Cheers,
    Curt Weinstein
    Semmes Weinstein Corp.



    David Mendosa is a freelance journalist and consultant specializing in diabetes and lives in Boulder, Colorado. When he was diagnosed with type 2 diabetes in February 1994, he began to write entirely about that condition. His articles and columns have appeared in many of the major diabetes magazines and websites. His own website, David Mendosa’s Diabetes Directory, established in 1995, was one of the first and is now one of the largest with that focus. Every month he also publishes an online newsletter called “Diabetes Update.” Twice weekly he writes for his blog at http://blogs.healthcentral.com/diabetes/david-mendosa. He is a coauthor of What Makes My Blood Glucose Go Up...And Down? (New York: Marlowe & Co., August 2003, and second American edition coming July 10, 2006, and other publishers in the U.K., Australia, and Taiwan).


This article originally appeared in the January 2006 issue of Diabetes Wellness News, pages 1, 4, and 8.


Last modified: February 4, 2006

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