- First, apply the tuning fork on the patient’s wrist (or elbow or clavicle) to demonstrate what the sensation feels like.
- Ensure the patient cannot see whether or where the examiner applies the tuning fork.
- Apply the tuning fork to a bony part on the dorsal side of the distal phalanx of the first toe (or another toe if the hallux is absent).
- Apply the tuning fork perpendicularly, with constant pressure (Figure 6).
- Repeat this application twice, but alternate this with at least one ‘mock’ application in which the tuning fork is not vibrating.
- The test is positive if the patient correctly answers at least two out of three applications, and negative if two out of three answers are incorrect.
- If the patient is unable to sense the vibrations on the toe, repeat the test more proximally (e.g., malleolus, tibial tuberosity).
- Encourage the patient during testing by giving positive feedback.
Proper method of using a 128 Hz tuning fork to check for vibratory sensation
