Range of Motion: 1st Toe Extension

The First Toe Extension Test measures how far the big toe extends at the first metatarsophalangeal joint. It can be measured actively or passively using a goniometer, inclinometer or consistent ROM process. The result can help compare sides, monitor change and add context to walking, running, calf raise, balance and foot strength assessments.

Introduction

A client may report difficulty pushing off during walking or running, feel restricted during calf raises or show reduced big toe extension on one side. The First Toe Extension Test helps measure this movement in degrees.

The first MTP joint contributes to push-off and foot mechanics during gait. However, static ROM does not always match dynamic function during walking. A 2020 study reported that clinical first MTP dorsiflexion measurement and dynamic function during walking are not always directly aligned, so results should be interpreted with functional findings.  

Quick Summary

Test name: Ankle First Toe Extension Test
Also known as: Hallux extension ROM test, first MTP dorsiflexion test
Purpose: Measure big toe extension range of motion
Movement: Big toe moving upward into extension
Joint/body region: First metatarsophalangeal joint
Plane: Sagittal plane
ROM type: Active ROM, passive ROM or both
Score: Degrees of first toe extension
Equipment: Goniometer, inclinometer or Measurz ROM workflow
Best used with: Gait, running, calf raise, balance, foot strength and ankle ROM assessments
Key limitation: Static toe ROM does not always reflect dynamic toe function during walking or running

What Is the First Toe Extension Test?

The First Toe Extension Test measures extension at the first metatarsophalangeal joint. This movement is often called hallux dorsiflexion.

It is commonly assessed in weight-bearing or non-weight-bearing contexts, but the method should be recorded because values may differ.

Why It Is Used

The test is used to quantify first toe extension, compare sides and monitor change.

It can help inform:

Walking and running assessment
Push-off movement assessment
Calf raise interpretation
Foot strength programming
Footwear or training discussions
Progress tracking over time

What It Measures

The test measures the angle of first MTP extension in degrees.

It may be influenced by:

First MTP joint movement
Foot posture
Toe strength and control
Pain or stiffness
Plantar fascia tension
Measurement method
Weight-bearing status
Previous loading
Footwear history

The result does not explain the cause of movement difference on its own.

Active vs Passive Range of Motion

Active first toe extension measures how far the client can lift the big toe using their own control.

Passive first toe extension measures how far the toe can be moved by the professional.

Passive values are often higher than active values. Both should be recorded separately when both are tested.

Who It Is Useful For

This test may be useful for runners, walkers, dancers, field sport athletes, gym clients, older adults and clients where foot push-off, balance or toe mobility is relevant.

Equipment Required

Small goniometer or inclinometer
Chair or treatment table
Pain scale
Measurz for recording ROM
Optional weight-bearing setup
Optional comparison side notes

Step-by-Step Protocol or How to Apply This in Practice

Starting position

Choose non-weight-bearing or weight-bearing testing and record the method.

Client position

For non-weight-bearing testing, position the client sitting or lying with the foot relaxed.

For weight-bearing testing, position the client standing or in a lunge-style setup where the first toe can extend.

Professional position

Sit or stand near the foot with access to the first metatarsal and proximal phalanx.

Body/joint setup

Keep the first ray stable and align the toe without forcing rotation.

Stabilisation

Stabilise the first metatarsal just proximal to the joint. Avoid allowing the whole foot to move.

Movement instruction

For active ROM, ask the client to lift the big toe upward.

For passive ROM, gently extend the big toe at the first MTP joint until the first firm endpoint, symptom limit or agreed end range.

Measurement landmarks

For goniometry, align the axis over the first MTP joint, stationary arm along the first metatarsal and moving arm along the proximal phalanx.

Inclinometer or device placement

If using an inclinometer, place it consistently on the toe or selected reference surface according to the protocol.

What to ask

Ask about pain, stiffness, stretch, pressure, symptom location and whether symptoms are familiar.

Stopping rules

Stop if pain increases, the toe cannot be stabilised, symptoms are not tolerated or compensation dominates.

What to record

Record active/passive ROM, side, degrees, pain score, symptom location, weight-bearing status, device and compensation.

Number of trials

Use one to three trials and record whether you use best or average.

Retest consistency

Use the same position, stabilisation, device, landmarks and endpoint each session.

Scoring and Interpretation

The score is recorded in degrees.

A lower value may show reduced first toe extension compared with the other side, baseline or selected reference value. A higher value shows more extension under the tested setup.

Interpretation is stronger when paired with:

Pain score
Symptom location
Active versus passive comparison
Side-to-side comparison
Calf raise testing
Gait or running findings
Foot strength
Balance performance

The result does not explain the cause of movement difference by itself.

Normative Data, Benchmarks or Reference Values

Evidence level: Level 2–3 — related reference values exist, but exact protocol-specific norms are limited.

Common teaching references often describe first MTP extension around 70 degrees, but values vary by population, age, symptoms, measurement method and weight-bearing status.

Practical benchmarks:

Compare both sides
Track baseline to retest
Compare active and passive ROM
Record pain at end range
Compare static ROM with gait, running or calf raise function
Use the same protocol each time

Reliability and Validity

A first MTP joint study published in 2020 reported that clinical maximum dorsiflexion measurement and dynamic function during level walking are not always directly aligned, supporting the need to interpret static ROM with movement findings.  

A reliability study comparing smartphone goniometry and traditional goniometry for first MTP dorsiflexion reported good intra-rater and inter-rater reliability for some measures, while also showing that different tools can produce different angle values.  

This means the same device and method should be used for retesting.

Common Errors and Testing Limitations

Common errors include failing to stabilise the first metatarsal, measuring whole-foot movement, changing weight-bearing status, forcing painful end range, inconsistent goniometer placement, confusing active and passive ROM, and assuming static ROM fully represents gait function.

Limitations include device variation, static versus dynamic differences, foot posture, symptoms, warm-up and examiner technique.

Practical Applications

Use first toe extension ROM to track foot mobility, compare sides, monitor symptoms and add context to gait, running, calf raise, balance and foot strength assessments.

How to Record This in Measurz

In Measurz, record baseline first toe extension ROM in degrees using the inclinometer or chosen device. Note whether the result is active or passive, side tested, pain score, symptom location, weight-bearing status, test position, device used and compensation notes.

Compare both sides and track progress across sessions. Add related calf strength, gait, running, balance or foot function findings.

Related Tests or Internal Linking Suggestions

Ankle Dorsiflexion Test
Ankle Plantarflexion Test
Weight-Bearing Lunge Test
Single-Leg Calf Raise Test
Gait Assessment
Running Assessment
Balance Tests

FAQs

What is normal first toe extension ROM?

Common references often describe around 70 degrees, but values vary by protocol, age, symptoms, foot structure and weight-bearing status.

How do you measure first toe extension?

Stabilise the first metatarsal, move the big toe into extension and measure the angle at the first MTP joint.

Should first toe extension be measured actively or passively?

Both can be useful. Active ROM shows controlled movement, while passive ROM shows available motion when guided.

Does static first toe ROM match walking function?

Not always. Static ROM should be interpreted with gait, running, calf raise and functional findings.

How should first toe extension be tracked?

Use the same position, device, landmarks, weight-bearing status and active/passive method each session.

Key Takeaways

First toe extension measures big toe movement at the first MTP joint.
Active and passive ROM should be recorded separately.
Static ROM does not always match dynamic function.
Side-to-side and baseline comparison are practical benchmarks.
Measurz should capture degrees, pain, side, method, device and related findings.

References

Buldt, A. K., Menz, H. B., Allan, J. J., Landorf, K. B., & Munteanu, S. E. (2020). First metatarsophalangeal joint range of motion is associated with lower limb kinematics in individuals with first metatarsophalangeal joint osteoarthritis. Journal of Foot and Ankle Research, 13, 33. https://doi.org/10.1186/s13047-020-00404-0 

Clarkson, H. M. (2020). Musculoskeletal assessment: Joint range of motion, muscle testing, and function (4th ed.). Wolters Kluwer.

Jones, R. K., et al. (2020). Reliability of a smartphone goniometer app compared with traditional goniometry for first metatarsophalangeal joint dorsiflexion. Needs verification.

Norkin, C. C., & White, D. J. (2016). Measurement of joint motion: A guide to goniometry (5th ed.). F. A. Davis.