October 2013

Neuropathy results in less sensory loss at fifth metatarsal than hallux

In the moment: Diabetes

By Emily Delzell

Clinicians should carry out quantitative vibration testing for sensory loss in patients at risk for diabetic neuropathy at the hallux, according to research that confirms the hallux undergoes greater sensory loss than the fifth metatarsal, an alternate location for vibration testing.

Researchers at Health Access Network in Lincoln, ME, used a 128-Hz electronic tuning fork to test vibration sensing in 28 patients with diabetes and neuropathy and 17 patients without either condition.

The clinicians conducted timed vibration tests (TVT), in which patients report the time at which vibration diminishes beyond their perception, at the hallux and the fifth metatarsal head in both groups.

Patients with diabetic neuropathy had significantly lower TVT values than controls at both locations. Among patients with diabetes and neuropathy, loss of sensation at the hallux was significantly greater than at the fifth metatarsal, and these patients perceived vibrations an average of 2.42 seconds longer at the fifth metatarsal than at the hallux.

The findings were published in September by the electronic journal Diabetic Foot & Ankle.


O’Brien T, Karem J. Relative sensory sparing in the diabetic foot implied through vibration testing. Diabet Foot Ankle 2013;4:21278.

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