Is moving the big toe and asking the patient to identify its position a reliable method to assess proprioception after a saphenous nerve injury?

Moving the Big Toe to Assess Proprioception is a Valid Clinical Method, Not Nonsense

Moving the big toe and asking the patient to identify its position is a valid and established clinical method for assessing proprioception, particularly in neurological examinations and when evaluating peripheral neuropathies. 1, 2

Clinical Importance of Proprioception Testing

• Proprioception is defined as the awareness of the mechanical and spatial state of the body and its musculoskeletal parts, which is critical for motor actions and contributes to our sense of body ownership 2
• Proprioceptive assessment is a key component of neurological examination and is particularly important in evaluating patients with peripheral neuropathies, such as diabetic neuropathy 1
• Clinical proprioceptive tests traditionally focus on a person's ability to detect, discriminate, or match limb positions or movements 2

Standardized Methods for Testing Proprioception

• The standard clinical method involves moving the patient's digit (often the big toe) up or down and asking the patient to identify the position while their eyes are closed 1
• This test assesses joint position sense, which is a fundamental aspect of proprioception 3
• Testing should be conducted in a quiet, relaxed setting to ensure patient focus and accurate responses 1
• The examiner should first demonstrate the test on a visible body part so the patient understands what to expect 4

Clinical Applications and Validity

• Proprioception testing is particularly important in diabetic peripheral neuropathy assessment, where it complements other sensory tests like monofilament testing and vibration perception 1
• The American Society of Anesthesiologists recommends postoperative assessment of extremity nerve function, which includes proprioception, to detect peripheral neuropathies early 4
• Proprioceptive deficits can occur as a result of traumatic damage to ligaments and muscles, and in association with painful disorders of gradual onset 3

Proper Technique for Accurate Assessment

• The patient must not be able to see whether or where the examiner moves the digit 4
• The examiner should alternate between actual movements and "mock" applications where no movement occurs 4
• The test is considered positive (normal) if the patient correctly answers at least two out of three applications 4
• Encourage the patient during testing by giving positive feedback 4

Clinical Significance of Findings

• Loss of proprioception is a significant finding that may indicate peripheral neuropathy, particularly in patients with diabetes 1
• Impaired proprioception has been reported in various musculoskeletal disorders affecting different body parts 3
• Proprioception deficits are associated with increased risk of falls and decreased functional mobility 5

While there are more sophisticated methods for quantitative assessment of proprioception, such as the Lower Extremity Position Test 6, the simple clinical test of moving the big toe and asking the patient to identify its position remains a valid and widely used method in clinical practice 1, 2.