The Fukuda stepping test (FST) is widely used in neurology and for the diagnosis of vertigo-associated disease, but its reliability is disputed. This study assessed the accuracy of the FST in determining the side of vestibular dysfunction in 126 patients with unilateral vestibular lesion. Abnormal deviation towards the side of the lesion occurred in 50.0% of cases and towards the intact side in 24.6% of cases, with 25.4% of patients within the normal range (< 45° deviation). An equal percentage of patients with acute stage vertigo (0-3 days after onset) deviated towards the intact and lesion sides, however the percentage of patients deviating to the intact side decreased over time. A subset of patients who originally deviated towards the intact side gradually began to deviate towards the lesion side. Care should be taken when using the FST to determine the side of the lesion, particularly in acute stage vertigo.