Joint Position Sense:

1. Grasp the patient's big toe and hold it away from the other toes to avoid friction.
   
   
2. Hold the sides of the toe so that the patient cannot work out the direction of movement from pressure on the toe.
   
   
3. Show the patient "up" and "down."
   
   
4. With the patient's eyes closed ask the patient to identify the direction you move the toe.
   
   
5. If position sense is impaired move proximally to test the ankle joint.

• If joint position sense is impaired, this also suggests dorsal column loss.

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