Diagnostic Tuning Fork

One of the most serious complications of diabetes is nerve damage leading to neuropathy. Diabetic nerve damage is most frequent in the distal portions of the body: the hands and feet. As a result, foot ulcers and amputations are much more common in elderly patients with diabetes compared to their healthy counterparts.
In order to detect the risk for neuropathy in a patient, a foot care practitioner should frequently re-assess his or her diabetic patients using the proper tests for neuropathy.

One effective method of testing for neuropathy in your patients is with a C128 tuning fork. This type of peripheral neuropathy test detects neuropathy at a much earlier stage than a monofilament test. It can be an accurate gauge of somebody's neuropathy and encourage them to better blood sugar control to prevent future problems.

To perform the test, a C128 tuning fork is struck to make the ends clang together, and then gently applied to a bone on the top or tip of the great toe. The tuning fork test can be performed again at the end of the dorsal bony prominence of the patient's big toe proximal to the nail. The patients will indicate when they can no longer feel the vibration.
Vibration sensation duration should be measured in both feet twice.
Normal score cutoff values are above 7.5 seconds in those aged 40–49, 6.9 seconds in the 50–59 age group, and 3.8 seconds in the 60–69 age group.

Equipment:

• 128 Hz tuning fork
• Good lighting
• Comfortable place for the patient to put their feet up
• Foot cleaning station or non-sterile gloves

Procedure:

1.Tap the tuning fork on the ball of your hand.
2.Apply base of the tuning fork to a bone on the top or tip of the great toe.
3.Ask patient if they can feel the “buzzing” or vibration. If they respond with a “yes,” tell them to inform you when the vibration stops.
4.An abnormal test result occurs when the patient informs you that the vibration stops before you can feel the vibration end.
5.This test can also be performed on the joint of the greater toe and the phalange or top of one of the smaller toes.