For Diabetic Neuropathy

1. Show normal
   • Strike the tuning fork against a solid surface to elicit a vibration
   • Apply the base of the tuning fork to the patient’s forehead or sternum and ensure the patient can sense normal vibration
2. Test X2 each foot

   • Have the patient close their eyes and apply the base of the vibrating tuning fork to the skin proximal to the nail bed of the great toe

     

   • Ask the patient to state when they no longer sense vibration then dampen the tuning fork with your other hand

   • Assign a score as follows:

     • 1 point for correct vibration sensation
     • 1 point for correct sensation of vibration cessation

   • Repeat on the same foot, then twice on the contralateral foot in an arrhythmic manner

   • Record the patient’s score – note that threshold scores do not exist for this method as they do for the monofilament test