1. Show the 10-g Semmes-Weinstein monofilament to the patient.
2. Touch it first to the patient’s forehead or sternum so that the sensation is understood.
3. Instruct the patient to say “yes” every time the monofilament stimulus is perceived.
4. With the patient’s eyes closed, apply the monofilament to the dorsum of the great toe proximal to the nail bed as shown in the illustration below. Use a smooth motion-touch the skin, bend the filament for a full second, then lift from the skin.
5. Perform this stimulus 4 times per foot in an arrhythmic manner so the patient does not anticipate when the stimulus is to be applied.
6. For each of the 8 stimuli, assign a score of 0 if it is not perceived, 0.5 if it is substantially less than that perceived on the forehead or sternum, and 1 if it is perceived normally. A score of 3 out of 8 correct responses means that the presence of neuropathy is likely. A score of 3.5 to 5 means that the risk of new onset neuropathy in the next four years is high. A score of 5.5 or greater indicates that there is a low risk of neuropathy onset in the next four years.