Examination of the sensation of the diabetic foot

Sensory testing

You may find the following equipment useful cotton wool monofilaments neurological pins 128Hz tuning fork or Rydell Seiffer tuning fork. Tuning forks of higher frequencies are not suitable for neuropathy testing Neurothesiometer or Biothesiometer
Use the cotton wool to test for light touch
Ten Gram Monofilaments are an accurate predictor of significant sensory loss. Press the fibre against the skin till it buckles.
When the Monofilament has buckled it exerts 10 Grams of force. If the patient cannot feel it they are most likely to be at risk of foot ulceration. Please see Monofilament page for more details of sites to test. Use your browser [Back] button to return to this page.
Use the tuning fork to test for vibration loss. Place it on the end of the big toe.
If you have a graduated tuning fork you can read the amount of vibration the patient can feel by asking the patient to say when vibration can no longer be felt and reading the point on the scale when this happens. Please see additional information sheet for more information.
The use of a Biothesiometer or Neurothesiometer is ideal for accurate measurement of vibration loss. The probe is placed on the big toe and the knob is turned so that vibration slowly increases from zero to its maximum of 25 volts. The patient should be asked to say when he first notices the vibration and a note of the value should be made. It is worth taking the average of 3 readings for accuracy. It should be remembered that vibration sensation decreases with age.
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