Physical Exam

Proprioception Toe Test

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Video coming September 2026

How to Perform

With the patient’s eyes closed, separate the great toe from the adjacent toe and grasp its distal phalanx by the sides to avoid pressure cues from the top or bottom. Move the toe slightly up or down in a random sequence, asking the patient to report the direction of each movement.

How to Interpret

Peripheral Neuropathy

Lower-extremity bedside cluster positive (≥2 of 3: Achilles reflex absent despite facilitation, vibration <10 seconds at toe with 128-Hz tuning fork, or position sense <8 of 10 1-cm trials at toe)

Rule in

HelpfulDerived CI

Rule out

Very helpfulDerived CI

Evidence:Limited

Impaired great toe proprioception (this sign alone)

Rule in

Somewhat helpfulDerived CI

Rule out

Not helpfulDerived CI

Evidence:Limited

References

Prabhakar AT, Suresh T, Kurian DS, Mathew V, Shaik AIA, Aaron S, Sivadasan A, Benjamin RN, Alexander M. Timed Vibration Sense and Joint Position Sense Testing in the Diagnosis of Distal Sensory Polyneuropathy. J Neurosci Rural Pract. 2019;10(2):273-277. PMID: 31001017.
Richardson JK. The clinical identification of peripheral neuropathy among older persons. Arch Phys Med Rehabil 2002;83(11):1553-1558. doi:10.1053/apmr.2002.35656. PMID 12422324.
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 9, 2026.