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.

What Is the Ankle 1st Toe Extension Strength Test?

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.

Step-by-Step Protocol / Practice

1. Prepare the client

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.

2. Set the client position

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

3. Set up the device or straps

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.

4. Place the device, strap or handle

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.

5. Stabilise the position

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.

6. Give clear instructions

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.

7. Record trials

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.

8. Identify invalid trials

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

9. Record symptoms

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.

Why It Is Used

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.

What It Measures

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

Understanding the Result, Reference Values and What to Look For

What a higher or lower result may suggest

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.

What can influence the result

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

Normative, reference and comparative values

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.

Practical interpretation priorities

Use this order:

1. Compare with the client’s own baseline.
2. Compare right and left sides when relevant.
3. Compare 1st toe extension with 1st toe flexion where relevant.
4. Consider symptoms during and after testing.
5. Consider confidence and effort quality.
6. Review whether compensations were present.
7. Compare with related strength, mobility or performance tests.
8. Relate the result to walking, running, sport, work, exercise or daily-life demands.
9. Retest under the same conditions to monitor change.
10. Do not use reference values as pass/fail criteria.

What to look at for each relevant Muscle Meter metric

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.

Assessing and Providing Context for Different Client Populations

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.

Reliability, Validity and Measurement Considerations

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 and Limitations

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

Practical Applications

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

Ideas to Make the Result Better

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.

Recommended Standard Protocol Summary

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

FAQs

What does the Ankle 1st Toe Extension Strength Test measure?

It measures isometric big-toe extension force output in a specific test setup.

Should the result be recorded as percentage of body weight?

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.

Are there universal 1st toe extension norms for the Muscle Meter?

Published universal Muscle Meter norms for this exact protocol appear limited. Baseline, side-to-side comparison and repeated testing are usually more useful.

What numerical values are available for comparison?

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.

Can this test diagnose a big-toe, tendon or nerve condition?

No. It can measure force output, but it does not diagnose a condition or explain symptoms on its own.

Why is big-toe isolation important?

If the client lifts the whole foot or extends all toes strongly, the result may not reflect 1st toe extension force clearly.

What can make the result unreliable?

Different toe placement, device slipping, whole-foot lifting, cramping, pain, poor stabilisation and inconsistent instructions can affect results.

What should be recorded in Measurz?

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.

Key Takeaways

• 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.

References

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