The Ankle 1st Toe Extension Strength Test measures how much force a client can produce when lifting the big toe upward against resistance. It is commonly used to assess hallux extension force output in a controlled isometric setup.
This test can provide useful context for foot clearance, toe control, gait, running, balance, sport preparation, lower-limb strength profiling and progress tracking. The 1st toe contributes to foot control during standing and movement, but a single toe extension score should not be used to explain symptoms, diagnose pathology or determine readiness for sport or work on its own.
The Muscle Meter is a handheld dynamometry tool used to measure force output during push, pull and isometric strength assessments. When used on its own, the Muscle Meter primarily measures peak force, which is the highest force value produced during the test. When used with Measurz, Muscle Meter data can be recorded and analysed with a broader set of strength and force-time metrics, including peak force, impulse, torque, rate of torque development, rate of force development, time to peak and fatigue index.
For routine 1st toe extension testing, peak force is usually the main metric. Force as a percentage of body weight may be useful if directly calculated from the client’s test force and body weight, especially for baseline comparison, side-to-side comparison and retesting. Rate of force development and time to peak may be useful when rapid toe lift or foot clearance is relevant. Impulse may be useful if sustained toe extension over a defined time window is intentionally tested. Fatigue index is only relevant if repeated or sustained toe extension efforts are part of the protocol.
The Ankle 1st Toe Extension Strength Test is an isometric force assessment where the client lifts the big toe upward into the Muscle Meter without visible movement of the foot or ankle. The device is usually placed over the dorsal surface of the hallux or against the top of the toe, depending on the setup.
The movement direction is 1st toe extension. The purpose of the test is to measure how much upward force the client can produce through the big toe in a specific position.
Consistent setup matters because toe position, ankle position, device placement, foot support, stabilisation, toe contact point and client effort can all affect the result. This test measures force output in a specific setup. It does not fully measure walking ability, balance, running performance, foot posture, pain, endurance or movement quality on its own.
Explain that the test measures how strongly they can lift the big toe upward into the Muscle Meter. Record baseline symptoms, big-toe discomfort, forefoot discomfort, dorsal foot symptoms, cramping, fatigue, recent activity and confidence with maximal effort.
Use at least one submaximal practice trial so the client understands the direction of force. This is important because some clients may lift all toes, dorsiflex the ankle or move the whole foot instead of isolating the big toe.
A common setup is seated with the hip and knee flexed, the ankle near neutral and the foot supported. The heel and midfoot should be stable so the client can extend the big toe without lifting the whole foot.
Record:
Seated or long-sitting position
Knee angle
Ankle start position
Foot support
Big-toe start position
Whether footwear was removed
Whether the lesser toes were relaxed or stabilised
For a handheld setup, place the Muscle Meter over the big toe so the client lifts upward into the device. For improved repeatability, especially with small toe forces, use a stable support surface and consistent device placement.
If using a strap, toe cap or small contact attachment, record the setup carefully. Small changes in toe contact point can noticeably change the score.
Place the Muscle Meter against the top of the big toe, commonly near the distal or mid-toe region depending on comfort and the intended setup. Avoid uncomfortable pressure over the nail, skin fold or painful joint area.
The force direction should be big-toe extension rather than ankle dorsiflexion, whole-foot lifting, lesser-toe extension or leg movement.
Stabilise the foot so the client does not compensate with ankle movement, forefoot lift, whole-foot pulling, lesser-toe extension or body movement. The aim is controlled 1st toe extension force.
Stabilisation should allow the big toe to lift strongly while keeping the rest of the foot position repeatable.
Use consistent instructions such as:
“Lift your big toe up into the device as hard as you can and hold.”
“Keep the rest of the foot still.”
“Try not to lift the whole foot.”
“Build up smoothly, then pull hard.”
“Keep breathing.”
“Tell me if you feel pain, cramping, tingling or anything unusual.”
Use the same wording at retest where possible.
Use 1–2 practice trials, then record 2–3 maximal trials. A common contraction duration is 3–5 seconds. Some toe extension research uses longer holds, but a shorter 3–5 second test is often more practical for routine Muscle Meter testing.
Rest for 30–60 seconds between trials, or longer if cramping, symptoms or fatigue occur. Record whether the final score uses the best trial or the average of recorded trials. Either approach may be used if it is applied consistently.
Repeat or mark a trial as invalid if:
The ankle dorsiflexes
The whole foot lifts
The heel lifts
The device slips
The big toe loses contact with the device
Lesser-toe extension dominates the effort
The client pulls through the leg or body
Pain or cramping limits effort
The client holds their breath excessively
The setup changes between trials
Record big-toe pain, forefoot discomfort, dorsal foot symptoms, cramping, tingling, confidence, apprehension and symptom response after testing. Do not repeatedly test through high pain, worsening symptoms or strong cramping.
For retesting, match the same position, device placement, instructions, contraction duration, rest period, scoring method and symptom recording.
The Ankle 1st Toe Extension Strength Test is used to quantify big-toe extension force output in a repeatable setup. It may be useful for:
Baseline foot and toe strength assessment
Side-to-side comparison
Monitoring change over time
Foot and toe strength profiling
Comparing toe extension with toe flexion where relevant
Supporting foot clearance and gait assessment reasoning
Supporting balance and lower-limb control reasoning
Workplace context where walking, stairs, ladders or prolonged standing are relevant
Fitness and performance progress tracking
Client education
The test should support assessment reasoning. It should not be used as a stand-alone diagnostic or clearance measure.
The test primarily measures isometric 1st toe extension force output in the chosen setup. It reflects the client’s ability to produce upward force through the hallux.
It may provide useful information about:
Big-toe extension force capacity
Side-to-side force difference
Big-toe control
Confidence lifting the big toe
Pain response during resisted toe extension
Change in toe force over time
Relationship between toe strength and related functional tasks
It does not directly measure:
Cause of dorsal foot pain
Joint mobility
Tendon integrity
Nerve function
Foot posture
Balance
Gait quality
Running performance
Endurance
Readiness to return to sport or work
A higher score may suggest greater 1st toe extension force output in that specific test setup. A lower score may suggest reduced hallux extension force output, but the reason should be interpreted carefully.
Lower force may be influenced by pain, apprehension, poor familiarisation, fatigue, cramping, guarding, inconsistent device placement, poor foot stabilisation, toe stiffness, reduced confidence or compensation from the ankle or whole foot.
One result should not be interpreted in isolation. Interpretation is strongest when the same setup is repeated over time and reviewed alongside symptoms, confidence, toe mobility, foot posture, gait, balance, ankle dorsiflexion strength, calf strength, hopping, running or work-specific tasks.
Important influences include:
Pain
Apprehension
Poor familiarisation
Fatigue
Cramping
Guarding
Poor foot stabilisation
Whole-foot lifting
Lesser-toe extension
Different device placement
Different toe position
Different ankle position
Breath holding
Client confidence
Pressure discomfort from the device
Published Muscle Meter-specific universal norms for 1st toe extension are limited. Because of this, reference values should be used as context only and not as direct targets unless the protocol is closely matched.
More user-friendly comparison data include:
In a healthy adult sample tested with a load-cell device, hallux extension force ranged from 23.1–82.0 N, with an average of 52.0 ± 12.3 N. In practical terms, 52 N is roughly similar to about 5 kg of force.
In the same study, hallux flexion was stronger than extension, ranging from 32.0–142.4 N, with an average of 88.9 ± 29.8 N. This is useful because it shows that big-toe extension is often weaker than big-toe flexion in that type of setup.
The device validation found repeated testing was highly consistent, with human intrasession reliability around ICC 0.905–0.916. This supports the value of repeated testing when the same setup is used.
A later ToeScale study found older-vs-younger differences in great toe extension strength of about 7–8 N, and male-vs-female differences of about 10–16 N, depending on the strength parameter. These differences show why age and sex can influence toe extension strength.
For side-to-side comparison, a difference of around 10% or more is often worth reviewing more closely in strength testing, especially if it matches symptoms, previous injury, poor confidence or a functional difference. This is not a strict pass/fail cut-off.
If force is recorded as a percentage of body weight in Measurz, use it mainly for the client’s own baseline, side-to-side comparison and retesting. Published bodyweight-percentage norms for this exact Muscle Meter 1st toe extension setup are not currently strong enough to use as universal targets.
These values are best used as comparison data. They can help provide context, but they should not be used as diagnostic, clearance or pass/fail cut-offs.
Use this order:
Compare with the client’s own baseline.
Compare right and left sides when relevant.
Compare 1st toe extension with 1st toe flexion where relevant.
Consider symptoms during and after testing.
Consider confidence and effort quality.
Review whether compensations were present.
Compare with related strength, mobility or performance tests.
Relate the result to walking, running, sport, work, exercise or daily-life demands.
Retest under the same conditions to monitor change.
Do not use reference values as pass/fail criteria.
Peak force
Use for maximum 1st toe extension force output, baseline strength, side-to-side comparison, progress tracking and comparing force across retests. Look for best score or average score, consistent setup, side-to-side difference, change from baseline, pain response and compensation during maximal effort.
Force as percentage of body weight
Use only when calculated directly from test force and body weight. Look for changes over time and differences between sides, but do not treat it as a universal target unless the comparison data use the same method.
Torque
Use only when the lever arm is measured and a more biomechanical interpretation is needed. It can help when toe length or device contact point changes the raw force reading. It should not be used as normative data unless the reference data match the setup closely.
Rate of force development
Use when rapid toe extension or foot clearance matters. Look for early force production and whether RFD changes while peak force stays similar.
Time to peak
Use to understand whether force is produced quickly or gradually. Look for delayed peak force, faster time to peak across retests, and whether a slower time reflects caution, pain, poor cueing or an actual performance difference.
Impulse
Use only if a defined sustained force window is intentionally tested. Look for whether the client can sustain toe extension force briefly and whether impulse improves while peak force stays similar.
Fatigue index
Use only if repeated or sustained 1st toe extension efforts are part of the protocol. Look for drop-off across repeated trials, symptom-related fatigue and whether fatigue improves across a training block.
Youth clients
Consider growth, maturation, coordination, attention, training age and familiarisation. Practice trials are important because toe isolation can be difficult for younger clients.
Adults and general fitness clients
Use the test for baseline foot strength, progress tracking and confidence with loading. Compare results with toe mobility, ankle strength, calf strength, balance and general exercise goals.
Older adults
Consider balance, transfers, daily tasks, walking confidence, fatigue, rest periods and function. Toe extension strength may provide useful context for foot control and walking tasks, but it should not be interpreted without functional assessment.
Athletes and sport clients
Consider sprinting, jumping, cutting, landing, foot clearance and push-off demands. Peak toe extension force alone does not equal sport performance, but it can support a broader lower-limb and foot strength profile.
Workplace and manual task clients
Consider uneven ground, stairs, ladders, prolonged standing, walking, carrying and footwear demands. Do not use one score to clear work duties.
Clients returning after injury
Use the test to monitor force output, confidence and symptom response. Toe strength alone should not confirm readiness.
Clients with pain or persistent symptoms
Pain, fear, guarding, cramping, fatigue, apprehension and confidence may reduce force. Record symptom response carefully and compare with related tests.
Higher body mass clients
Absolute force and force relative to body mass may both be useful. Interpret results in relation to goals, symptoms and functional demands, not assumptions about body size.
Repeatability improves when the same setup is used each time. Record and standardise:
Same test position
Same foot support
Same device attachment
Same device placement
Same toe contact point
Same ankle position
Same toe start position
Same stabilisation
Same instructions
Same contraction duration
Same rest period
Same scoring method
Same symptom and compensation recording
Toe extension testing is highly setup-dependent because small changes in toe position, pressure point and foot stabilisation can change the result. This makes baseline comparison and consistent retesting especially important.
Common errors include:
Lifting the whole foot instead of the 1st toe
Lesser-toe extension dominating the test
Ankle dorsiflexion compensation
Heel lift
Device slipping
Inconsistent toe placement
Inconsistent foot support
Testing through high pain or cramping
Breath holding
Comparing different protocols directly
Treating the score as a diagnosis
Limitations include:
Testing is setup-dependent
Muscle Meter-specific universal norms may be limited
Published toe extension studies may use different devices and positions
Pain, fear, guarding or cramping can reduce force output
Peak force does not measure endurance or movement quality
Toe extension strength does not fully explain balance, gait, running or sport performance
Strong symmetry does not automatically indicate readiness for sport or work
The Ankle 1st Toe Extension Strength Test may be useful for:
Baseline foot strength assessment
Side-to-side comparison
Comparing toe extension and toe flexion contribution
Monitoring response to exercise or intervention
Supporting gait and foot-clearance assessment reasoning
Reviewing toe control during lower-limb tasks
Client education
Comparing with ankle dorsiflexion, calf strength, toe mobility and functional tests
If force is low on both sides, consider assessing toe mobility, ankle dorsiflexion strength, calf capacity, balance, gait, footwear comfort and confidence with loading.
If one side is much lower, compare with symptoms, injury history, toe mobility, ankle strength, calf strength, balance and functional tasks.
If pain or cramping limits the result, record symptom location and review whether device placement, toe position or effort level needs modification.
If force is good but function is limited, compare with gait, balance, hopping, running mechanics, change-of-direction tasks or sport/work demands.
If the client is improving, keep the same test setup and monitor whether force, symptoms, confidence and function improve together.
Position: Seated, foot supported, ankle near neutral
Start position: Big toe relaxed, with the same start position used at retest
Joint or trunk angle: Record knee, ankle and big-toe position
Trials: 1–2 practice trials, then 2–3 recorded trials
Contraction duration: 3–5 seconds
Rest: 30–60 seconds between efforts
Metric: Peak force, plus percentage of body weight only if directly calculated
Attachment or device setup: Muscle Meter over or against the dorsal surface of the 1st toe, with consistent contact point
Final score: Best trial or average of trials
Key retesting requirement: Same foot support, toe position, device placement, instructions, contraction duration, rest and scoring method
It measures isometric big-toe extension force output in a specific test setup.
It can be if you calculate it directly from test force and body weight. Use it for internal comparison rather than as a universal target.
Published universal Muscle Meter norms for this exact protocol appear limited. Baseline, side-to-side comparison and repeated testing are usually more useful.
One load-cell study reported hallux extension force ranging from 23.1–82.0 N, with an average of 52.0 ± 12.3 N in healthy adults. These are not direct Muscle Meter targets unless the protocol is closely matched.
No. It can measure force output, but it does not diagnose a condition or explain symptoms on its own.
If the client lifts the whole foot or extends all toes strongly, the result may not reflect 1st toe extension force clearly.
Different toe placement, device slipping, whole-foot lifting, cramping, pain, poor stabilisation and inconsistent instructions can affect results.
Record side, foot position, big-toe start position, device placement, peak force, percentage of body weight if directly calculated, symptoms, compensations, confidence, scoring method and related findings.
The Ankle 1st Toe Extension Strength Test measures isometric big-toe extension force output.
Peak force is usually the main routine Muscle Meter metric.
Published examples include hallux extension force around 23.1–82.0 N, with an average of 52.0 ± 12.3 N, but protocols vary.
Percentage of body weight should only be used when calculated directly from force and body weight.
Baseline comparison, side-to-side comparison and retesting consistency are usually more useful than broad norms.
Reference values provide context, not diagnostic or clearance cut-offs.
Measurz should capture setup, symptoms, bodyweight-normalised values where directly calculated, compensations and retesting conditions.
Chandrashekhar, R., Perez, L. F., & Wang, H. (2024). Characterization of great toe extension strength using ToeScale—A novel portable device. Sensors, 24(15), 4841. https://doi.org/10.3390/s24154841
Hile, E. S., Ghazi, M., Chandrashekhar, R., Rippetoe, J., Fox, A., & Wang, H. (2023). Development and earliest validation of a portable device for quantification of hallux extension strength (QuHalEx). Sensors, 23(10), 4654. https://doi.org/10.3390/s23104654
Quinlan, S., Fong Yan, A., Sinclair, P., & Hunt, A. (2020). The evidence for improving balance by strengthening the toe flexor muscles: A systematic review. Gait & Posture, 81, 56–66. https://doi.org/10.1016/j.gaitpost.2020.07.006
Spink, M. J., Fotoohabadi, M. R., Menz, H. B., & Lord, S. R. (2010). Foot and ankle strength assessment using hand-held dynamometry: Reliability and age-related differences. Gerontology, 56(6), 525–532. https://doi.org/10.1159/000264655
