Monofilament Testing: November 2025 Competency

Monofilament testing is a critical screening tool used to assess protective sensation in the feet, primarily for patients with diabetes, neuropathy, or vascular disease. The loss of protective sensation (LOPS) is a major risk factor for foot ulcers, infection, and amputation. Early detection through standardized sensory testing allows for prompt intervention, patient education, and prevention of avoidable complications.

This competency validates the clinician’s ability to perform monofilament testing using the correct sites, pressure, and timing, and to interpret results accurately. It also reinforces infection prevention, patient positioning, and documentation practices.

What We Are Assessing

• Performance of hand hygiene and preparation of the monofilament device per infection control standards.
• Proper patient positioning with both feet comfortably supported and visible.
• Application of the monofilament perpendicular to the skin with enough pressure to bend the filament.
• Avoidance of callused or damaged skin during testing (use intact skin near the recommended sites).
• Consistent contact time of approximately one second before removing the filament.
• Completion of testing at all recommended sites:
  • Plantar surface of the great toe
  • Metatarsal heads 1, 3, and 5 (both feet)
• Proper cleaning or disposal of the monofilament per agency policy after testing.

Clinical Rationale

• Loss of sensation increases the risk for unnoticed injury, ulcer formation, and infection.
• Monofilament testing helps identify peripheral neuropathy early, supporting preventive care and patient education.
• Accurate and consistent testing at each visit allows trend comparison and helps tailor individualized care plans.
• Asymmetry or newly diminished sensation should prompt provider notification and further vascular or neurological evaluation.

Documentation Expectations

• Record the testing sites and results (e.g., “sensation intact,” “diminished,” or “absent”).
• Document laterality (right, left, or bilateral) and any patient-reported symptoms such as numbness, tingling, or burning.
• Include patient education provided regarding daily foot inspection, footwear, and injury prevention.
• Notify the provider and document follow-up if sensation is diminished or absent.

Supplies at the Station

• 10-gram monofilament (in-date and intact).
• Hand hygiene supplies and gloves (if required per policy).
• Surface disinfectant or disposal container for single-use monofilaments.
• Patient assessment documentation sheet.

Validation process: Clinicians will demonstrate correct technique, site selection, pressure, and timing. Observers will assess infection control, accuracy, and communication with the simulated patient. If the first attempt is not satisfactory, the clinician will review the competency materials and return for a second attempt during the session (as time allows). If still not satisfactory, 1:1 remediation will be scheduled on November 19, 2025 between 8:00 AM t0 10:00 AM, per standard process.