Assessing Vibration Sensation in Diabetic Patients

Proper Technique for Vibration Testing

The American Diabetes Association recommends using a 128-Hz tuning fork to test large-fiber function, which should be performed along with at least one other sensory test such as 10-g monofilament testing to properly identify loss of protective sensation 1, 2, 3
Vibrate the tuning fork by striking it on a covered elbow or knee, and place the vibrating tuning fork on a bony prominence, such as the dorsal aspect of the distal interphalangeal joint of the great toe, to assess vibration sensation 4, 5, 1, 3

The American Diabetes Association recommends assessing vibration sensation using a 128-Hz tuning fork, 10-g monofilament testing, temperature or pinprick sensation, and ankle reflex tests as part of a comprehensive diabetic foot examination protocol 1, 2, 3, 6
For patients with type 1 diabetes, the American Diabetes Association recommends starting assessments 5 years after diagnosis and at least annually thereafter, and for patients with type 2 diabetes, starting at diagnosis and at least annually thereafter 2, 3
More frequent assessments are recommended for patients with histories of ulcers, amputations, foot deformities, or peripheral arterial disease 7

Vibration testing specifically assesses large-fiber function, which is crucial for detecting early diabetic peripheral neuropathy, with up to 50% of cases being asymptomatic, making objective testing essential 3, 8
Loss of vibration sensation is a risk factor for diabetic foot ulceration and amputation, with a sensitivity of 70% and specificity of 90% in detecting severe neuropathy 1, 7

Vibration testing alone is insufficient, and at least two normal tests are needed to rule out loss of protective sensation, with vibration sense testing being more accurate when performed on bony prominences rather than soft tissue 1, 7, 4, 5