The Supination Resistance Test estimates how much external force is required to initiate supination of the foot while the client stands in weight-bearing. It is commonly used in foot and ankle biomechanics to help understand how easily or difficultly the foot can be moved into a more supinated position.
A higher resistance finding may suggest greater external force is required to supinate the foot and may be associated with medial foot and ankle loading demands. A lower resistance finding may suggest the foot supinates more easily and may be relevant in some lateral ankle presentations. However, the test does not diagnose any condition on its own and should be interpreted with history, symptoms, foot posture, strength, gait and other assessment findings.
The Supination Resistance Test is a foot and ankle special test used to estimate the amount of force required to supinate the foot in standing. It can be performed manually or with a measurement device that quantifies the force.
The test is often used in podiatry, biomechanics, foot orthosis reasoning and lower-limb assessment. It may provide information about how much external force is needed to initiate a supination movement of the rearfoot and midfoot while the foot is loaded.
In modern research, instrumented versions of the Supination Resistance Test are being studied in relation to foot and ankle biomechanics, posterior tibial tendon dysfunction, plantar fasciopathy, chronic ankle instability and foot orthoses. This makes it a useful test for assessment reasoning, but it should still be interpreted carefully.
The Supination Resistance Test should not be used as a stand-alone diagnostic test. A high or low result may support assessment reasoning, but it does not confirm or exclude pathology.
Test name: Supination Resistance Test
Region: Foot and ankle
Primary purpose: Estimate force required to initiate foot supination in standing
Commonly associated presentations: Posterior tibial tendon dysfunction, plantar fasciopathy, chronic ankle instability, foot posture assessment, foot orthosis reasoning
Positive finding: Increased or decreased resistance compared with expected presentation, opposite side or reference context
Negative finding: Resistance appears within expected range and is not meaningfully different from the comparison side or relevant reference context
Best used with: Foot Posture Index, gait observation, Jack’s Test, heel raise testing, calf strength, balance and symptom history
Main limitation: It is not a stand-alone diagnostic test.
The Supination Resistance Test estimates the external force needed to initiate supination of the foot in weight-bearing.
In the manual version, the professional places the fingers under the medial side of the foot, often near the navicular region, and applies an upward force to begin supinating the foot. The professional then rates the resistance subjectively.
In instrumented versions, a strap and force device are used to quantify the amount of vertical force required to initiate hindfoot inversion or foot supination. This may be reported in Newtons or as a percentage of body weight.
The test can provide insight into how difficult it is to move the loaded foot towards supination.
The Supination Resistance Test may be used to support assessment reasoning around:
Foot posture
Subtalar joint axis-related mechanics
Load on structures contributing to internal supination moments
Posterior tibial tendon dysfunction presentations
Plantar fascia-related presentations
Chronic ankle instability presentations
Foot orthosis reasoning
Wedging and footwear discussions within professional scope
Side-to-side differences
Monitoring changes over time
The test may help professionals understand whether the foot appears relatively easy or difficult to supinate when loaded.
The test assesses the resistance of the foot to external supination force during standing.
It may provide information about:
Supination resistance
Side-to-side difference
Foot stiffness or mobility context
Potential tissue loading context
Relationship to foot posture
Relationship to foot orthosis response
Differences between medial and lateral foot/ankle presentations
It does not directly assess:
Tendon integrity
Ligament integrity
Plantar fascia structure
Imaging findings
Pain source
Foot strength
Balance
Gait mechanics with certainty
Diagnosis
Readiness for sport or work
The Supination Resistance Test may be useful for clients with:
Medial foot or ankle symptoms
Posterior tibial tendon dysfunction-type presentations
Plantar heel symptoms
Chronic ankle instability-type presentations
Pronated or supinated foot posture
Foot orthosis or footwear assessment needs
Lower-limb loading concerns
Sport or work tasks involving repeated foot loading
It may also be useful for professionals learning tissue-stress reasoning and foot biomechanics.
Consider using the Supination Resistance Test when:
Foot posture may be relevant to symptoms or movement
You want to compare right and left foot supination resistance
Posterior tibial tendon load is part of the assessment reasoning
Chronic ankle instability is being considered within a broader assessment
Foot orthosis reasoning is relevant
You are tracking response to footwear, orthosis or load changes
You want to add mechanical context to gait and movement observations
Use caution or avoid the test when:
The client cannot stand safely
Weight-bearing is highly painful
There is acute foot or ankle trauma
There is suspected fracture or acute inflammatory flare
The client has severe foot sensitivity
The test reproduces sharp or worsening symptoms
The professional cannot apply force safely or consistently
The client is unable to relax the foot during testing
Stop if the client reports sharp pain, cannot tolerate the position, or actively resists the test.
For the manual version:
No special equipment
Measurz app
Pain scale
Notes field for qualitative scoring
For an instrumented version:
Validated supination resistance measurement device
Non-stretch strap
Force gauge
Flat testing surface
Measurz app
Body weight value if reporting percentage of body weight
Ask the client to stand barefoot on a flat surface. The feet should be in a natural relaxed stance.
Record whether the test is:
Manual
Instrumented
Barefoot
In footwear
With or without orthoses
On a level surface
On a wedged or inclined surface
For standard testing, use barefoot standing on a level surface.
The client stands with:
Feet in natural stance
Weight evenly distributed
Knees relaxed
Hips facing forward
Eyes looking forward
Arms relaxed or lightly supported if needed
The client should not actively assist or resist the movement.
The professional positions themselves beside or slightly in front of the tested foot.
They should be able to:
Apply vertical force safely
Observe the rearfoot
Feel or measure the start of supination
Compare sides
Ask about symptoms
For the manual version, place the index and middle fingers under the medial side of the foot, commonly near the navicular region, and apply upward vertical force.
For an instrumented version, place the strap according to the device protocol, commonly passing under the foot from the lateral region towards the medial midfoot/navicular region.
Do not manually hold the foot in a corrected position.
The goal is to measure or estimate resistance, not to force a correction.
Apply upward vertical force to initiate foot supination or hindfoot inversion.
The force should be smooth and gradual.
Tell the client:
“Stand relaxed and try not to help or resist the movement. I am going to apply an upward force under your foot to see how much resistance there is to initiating supination. Tell me if this reproduces any symptoms.”
A positive or meaningful finding depends on the clinical question.
Examples include:
High resistance compared with the opposite side
Low resistance compared with the opposite side
Marked difference from expected response
Symptom reproduction during the test
High resistance in a medial foot or ankle presentation
Low resistance in a lateral ankle instability presentation
Large change when tested with footwear, orthoses or wedging
The direction of significance must be interpreted in context.
A negative or unremarkable finding may include:
Similar resistance side to side
No relevant symptom reproduction
Resistance appears consistent with the client’s profile
No meaningful difference with the assessment condition being tested
A negative result does not exclude foot or ankle pathology.
Stop if:
Pain increases sharply
The client cannot tolerate standing
The client actively resists or assists
The foot cannot be safely moved
Balance becomes unsafe
Symptoms become concerning
The test should be controlled. Avoid sudden force, excessive pulling or repeated painful testing.
A high Supination Resistance Test finding may suggest that more external force is required to initiate supination of the loaded foot. This may be associated with greater demand on structures that help generate internal supination moments, such as the posterior tibial tendon and related medial foot structures.
A low finding may suggest that the foot supinates more easily. In some presentations, this may be relevant when considering lateral ankle instability or reduced resistance to inversion/supination movement.
However, neither high nor low resistance confirms a condition. Supination resistance is influenced by body mass, foot posture, subtalar joint axis position, tissue stiffness, symptoms, guarding, stance and testing method.
A negative or unremarkable test may suggest that supination resistance does not appear to be a major distinguishing feature in that session. However, it does not exclude foot or ankle pathology.
The result is more meaningful when interpreted with:
Symptom history
Pain location
Foot posture
Foot Posture Index
Gait
Heel raise testing
Calf strength
Balance
Hop testing
Jack’s Test
Orthosis or footwear response
Activity demands
At the time of writing, high-quality peer-reviewed diagnostic accuracy evidence reporting sensitivity, specificity and likelihood ratios for the Supination Resistance Test as a stand-alone diagnostic test appears limited.
This means the test should be used as an assessment reasoning and biomechanical profiling tool rather than as a stand-alone diagnostic test.
Relevant evidence includes:
Research has shown that supination resistance differs across some foot and ankle musculoskeletal presentations.
In a 2023 case-control study, participants with chronic ankle instability showed lower supination resistance on the injured foot compared with the healthy foot.
The same study found that participants with posterior tibial tendon dysfunction showed greater supination resistance on the injured foot compared with the healthy foot.
No significant between-foot difference was observed for plantar fasciopathy or healthy controls in that study.
Supination resistance increased with valgus surface inclination and decreased with varus surface inclination.
These findings support biomechanical relevance but do not provide stand-alone sensitivity, specificity or likelihood ratios for diagnosis.
Because formal diagnostic accuracy values are limited, professionals should document the finding descriptively and interpret it cautiously.
Evidence suggests that instrumented versions of the Supination Resistance Test can demonstrate good to excellent reliability when performed with a validated device and standardised method.
Manual testing may be more subjective and depends on professional experience. Reliability may improve when the same professional uses a consistent scale and clear criteria.
Validity evidence supports the test as a measure related to the force required to supinate the foot in static standing. Research also suggests relationships between supination resistance, subtalar joint axis position, and some aspects of foot and ankle biomechanics.
However, the test should not be treated as a direct measure of tissue pathology or dynamic gait load in all situations. Static standing is not the same as walking, running or sport performance.
Reliability improves when the professional standardises:
Barefoot or footwear condition
Standing posture
Foot position
Force direction
Force speed
Device or hand placement
Number of trials
Symptom recording
Side-to-side comparison
Common errors include:
Applying force too quickly
Pulling diagonally instead of vertically
Allowing the client to help or resist
Not recording barefoot versus footwear condition
Not comparing sides
Not recording symptoms
Calling the test diagnostic
Treating manual resistance as a precise measurement
Not accounting for body mass
Not recording orthoses or wedging conditions
Limitations include:
Manual testing is subjective
Static testing may not reflect dynamic gait
Body mass influences resistance
Foot posture alone does not explain all results
Instrumented devices may not be available
Diagnostic accuracy values are limited
High or low resistance does not confirm pathology
The test should not be used alone for decision-making
The Supination Resistance Test may be useful for:
Foot and ankle biomechanical profiling
Side-to-side comparison
Posterior tibial tendon dysfunction-type assessment reasoning
Chronic ankle instability-type assessment reasoning
Plantar fascia load reasoning
Foot orthosis and footwear discussions within scope
Monitoring response to load or external support changes
Educating clients about foot mechanics
Supporting Measurz foot and ankle reports
In Measurz, it can be recorded alongside Jack’s Test, Foot Posture Index, heel raise testing, calf strength, ankle range of motion, balance, hop testing and gait observations.
Record the following:
Test name: Supination Resistance Test
Side tested
Result: high, low, expected, unclear or unable to test
Manual or instrumented method
Force value if measured
Percentage of body weight if calculated
Barefoot or footwear condition
Orthoses or wedges used, if any
Client position
Foot position
Force direction
Number of trials
Symptom location
Pain score
Symptom quality
Side-to-side comparison
Confidence in result
Irritability
Compensations
Reason for stopping, if relevant
Related findings
Assessment interpretation notes
Retest date if relevant
Recording these details improves repeatability, communication, client education, assessment reasoning, team consistency and reporting quality.
Jack’s Test
Foot Posture Index
Navicular Drop Test
Single-leg heel raise
Calf raise endurance test
Ankle dorsiflexion range of motion
Balance testing
Hop testing
Gait observation
Posterior tibial tendon assessment
Plantar fascia assessment
It estimates how much external force is required to initiate supination of the foot in standing.
No. It may support assessment reasoning, but it does not diagnose a condition on its own.
High resistance may suggest that more force is required to supinate the foot. This may be relevant in some medial foot and ankle presentations, but it needs context.
Low resistance may suggest the foot is easier to supinate. This may be relevant in some lateral ankle instability presentations, but it does not confirm anything on its own.
The manual test is subjective. Instrumented versions can quantify force more objectively.
Yes. Side-to-side comparison is often useful.
Yes. Footwear, orthoses and wedging can alter supination resistance, so testing conditions must be recorded.
Yes. Record pain location, pain score and symptom quality during the test.
The Supination Resistance Test estimates the force required to initiate foot supination in standing.
It may support assessment reasoning around foot mechanics, tissue loading and orthosis considerations.
High or low resistance findings must be interpreted in context.
Diagnostic accuracy values for the test as a stand-alone diagnostic tool are limited.
Instrumented testing is more objective than manual testing.
The result should be recorded carefully and interpreted alongside other Measurz assessment findings.
Griffiths, I. B., & McEwan, I. M. (2012). Reliability of a new supination resistance measurement device and validation of the manual supination resistance test. Journal of the American Podiatric Medical Association, 102(4), 278–289.
Moisan, G., Chicoine, D., McBride, S., Farahpour, N., Isabelle, P. L., Dagenais, C., & Griffiths, I. (2023). Supination resistance variations in foot and ankle musculoskeletal disorders: Implications for diagnosis and customised interventions with wedged insoles. Journal of Foot and Ankle Research, 16, 91. doi:10.1186/s13047-023-00681-5
Moisan, G., Isabelle, P. L., Gómez-Carrión, Á., Chicoine, D., Farahpour, N., Dami, A., Reguera-Medina, J. M., McBride, S., & Griffiths, I. (2026). Establishing normative values for the Supination Resistance Test: An international cross-sectional study. Journal of Foot and Ankle Research, 19(1). doi:10.1002/jfa2.70137
Payne, C. B., Munteanu, S. E., & Miller, K. (2003). Position of the subtalar joint axis and resistance of the rearfoot to supination. Journal of the American Podiatric Medical Association, 93(2), 131–135.
Payne, C. B., Oates, M. J., & Noakes, H. (2003). Static stance response to different types of foot orthoses. Journal of the American Podiatric Medical Association, 93(6), 492–498.
