Validity and Reliability of Criteria for Plantar Sensation Assessment Using Semmes-Weinstein Monofilament as a Clinically Usable Index

Abstract

There is no standard clinically adaptable criterion for assessing plantar sensation for pre- and post-intervention comparisons. Studies using Semmes-Weinstein monofilaments (SWMs) to investigate intervention effects on plantar sensation vary in procedure and do not consider measurement errors. This study aimed to develop a simple criterion using SWMs to assess plantar sensation, determine the measurement error range, and identify areas of low error. Six examiners assessed 87 healthy young adults in Experiment 1, while two examiners assessed 10 participants in Experiment 2. Filaments were graded from 1 to 20 based on increasing diameter. The smallest grade that could be perceived for three sequential stimuli was used as the criterion (smallest perceivable grade, SPG). The SPG was significantly smaller at the hallux and larger at the heel than at other sites. There were no significant differences between the SPG of the repeated tests performed by the same versus different examiners. The interquartile range of the differences was <±3 at all sites. Thus, our criteria were reliable in evaluating the effects of plantar sensation interventions, especially at the heel and the middle of the metatarsal heads and could contribute to the development of more effective treatments for plantar sensations.

Keywords: Semmes–Weinstein monofilaments; clinically usable index; plantar assessment; reliability; validity.

Figure 1

Representative records of a participant and the procedures and test sites of this study.

Figure 2

Comparison of the smallest perceivable grade (SPG) of healthy young adults at the hallux; 1st, 3rd, and 5th metatarsal heads (MTH), and heel. The SPG was converted to logarithms of the force (g) that each filament can apply, as measured and labeled by the producer. The symbol ° is indicates an outlier. *, p < 0.05.