Physical Exam

Proprioception Toe Test

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Video coming September 2026

How to Perform

With the patient's eyes closed, grasp the great toe by its sides (the lateral aspects, to avoid pressure cues from the top or bottom) and move it up or down in small increments, asking the patient to report the direction of each movement. If position sense is impaired distally, test a more proximal joint such as the ankle or knee.

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

Helpful

Rule out

Very helpful

Evidence:Limited

Peripheral Neuropathy (Large-fiber) or Dorsal Column Pathology

Impaired great toe proprioception

Rule in

Somewhat helpful

Rule out

—

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.