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Normal score cutoff values are above 7.5 seconds in those aged 40–49, 6.9 seconds in the 50–59 age group, and 3.8 seconds in the 60–69 age group. Vibration sensation duration should be measured in both feet twice. The patients will indicate when they can no longer feel the vibration. The tuning fork test can be performed again at the end of the dorsal bony prominence of the patient's big toe proximal to the nail. To perform the test, a C128 tuning fork is struck to make the ends clang together, and then gently applied to a bone on the top or tip of the great toe. It can be an accurate gauge of somebody's neuropathy and encourage them to better blood sugar control to prevent future problems. This type of peripheral neuropathy test detects neuropathy at a much earlier stage than a monofilament test. One effective method of testing for neuropathy in your patients is with a C128 tuning fork. In order to detect the risk for neuropathy in a patient, a foot care practitioner should frequently re-assess his or her diabetic patients using the proper tests for neuropathy. As a result, foot ulcers and amputations are much more common in elderly patients with diabetes compared to their healthy counterparts. Diabetic nerve damage is most frequent in the distal portions of the body: the hands and feet. One of the most serious complications of diabetes is nerve damage leading to neuropathy.