The Ankle Toe Flexion Strength Test measures how much force a client can produce when pressing the toes downward against resistance. Depending on the setup, this may assess lesser-toe flexion, combined toe flexion or toe grip-style force output in a controlled isometric position.

This test can provide useful context for foot strength, standing control, gait, push-off, balance, running, jumping, change-of-direction tasks and progress tracking. Toe flexion strength can be relevant to how the foot interacts with the ground, but a single toe strength score should not be used to explain pain, 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 toe flexion 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 force production matters, such as sprinting, jumping, cutting or push-off tasks. Impulse may be useful if sustained toe pressure over a defined time window is intentionally tested. Fatigue index is only relevant if repeated or sustained toe flexion efforts are part of the protocol.

What Is the Ankle Toe Flexion Strength Test?

The Ankle Toe Flexion Strength Test is an isometric force assessment where the client presses the toes downward into the Muscle Meter without visible movement of the foot or ankle. The device is usually placed under the plantar surface of the toes or against the toes in a way that allows a direct downward flexion force.

The movement direction is toe flexion. The purpose of the test is to measure how much downward force the client can produce through the toes in a specific position.

Consistent setup matters because toe position, ankle position, foot support, device placement, stabilisation, 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, running performance, balance, 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 press or grip the toes downward into the Muscle Meter. Record baseline symptoms, toe discomfort, forefoot discomfort, arch 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 press through the whole forefoot, plantarflex the ankle or move the leg instead of using the toes.

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 press through the toes without lifting or pushing the whole foot.

Record:

• Seated or long-sitting position
• Knee angle
• Ankle start position
• Foot support
• Toe start position
• Whether footwear was removed
• Whether the 1st toe was included or separated from the lesser toes

3. Set up the device or straps

For a handheld setup, place the Muscle Meter so the client presses the toes downward into the device. For improved repeatability, use a stable support surface and consistent device placement.

If using a strap, plate, bar or small contact attachment, record the setup carefully. Small changes in toe placement can change the score.

4. Place the device, strap or handle

Place the Muscle Meter under the plantar surface of the toes or against the toes in a way that allows a direct downward flexion force. Avoid uncomfortable pressure on the nails, skin folds or painful joint areas.

The force direction should be toe flexion rather than ankle plantarflexion, whole-foot pressing, heel lifting or forefoot rolling.

5. Stabilise the position

Stabilise the foot so the client does not compensate with ankle movement, forefoot lift, whole-foot pressing or body movement. The aim is controlled toe flexion force.

Stabilisation should allow the toes to press strongly while keeping the rest of the foot position repeatable.

6. Give clear instructions

Use consistent instructions such as:

“Press your toes down into the device as hard as you can and hold.”
“Keep the rest of the foot still.”
“Try not to push through the whole foot.”
“Build up smoothly, then press 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. 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 plantarflexes
• The whole forefoot presses down
• The heel lifts
• The device slips
• The toes lose contact with the device
• The client pushes 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 toe pain, forefoot discomfort, arch 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 Toe Flexion Strength Test is used to quantify toe flexion force output in a repeatable setup. It may be useful for:

• Baseline foot strength assessment
• Side-to-side comparison
• Monitoring change over time
• Foot and toe strength profiling
• Comparing 1st toe and lesser-toe contribution where relevant
• Supporting gait, running and push-off 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 toe flexion force output in the chosen setup. Depending on placement, it may reflect combined toe flexion force or lesser-toe flexion force.

It may provide useful information about:

• Toe flexion force capacity
• Side-to-side force difference
• Big-toe versus lesser-toe contribution if tested separately
• Confidence pressing through the toes
• Pain response during resisted toe flexion
• Change in toe force over time
• Relationship between toe strength and related functional tasks

It does not directly measure:

• Cause of forefoot pain
• Joint mobility
• Tendon integrity
• 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 toe flexion force output in that specific test setup. A lower score may suggest reduced toe flexion 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 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, foot posture, toe mobility, balance, gait, 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 pressing
• 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 combined toe flexion 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 one healthy adult sample using a load-cell protocol, hallux flexion force ranged from 32.0–142.4 N, with an average of 88.9 ± 29.8 N. In practical terms, 89 N is roughly similar to about 9 kg of force.
• Published pressure-mat toe flexion examples in healthy young adults have reported values around 62.6 ± 43.9 N, and sex-specific values around 31.5 ± 16.8 N for women and 65.8 ± 28.0 N for men. These values vary widely because protocols and devices differ.
• One study of healthy young adult men reported first-toe flexor strength of 1.54 ± 0.44 N/kg and lesser-toe flexor strength of 0.95 ± 0.29 N/kg. In practical terms, for a 70 kg person, this would roughly equal 108 N for the 1st toe and 67 N for the lesser toes if the setup is comparable.
• Toe flexor strength has shown moderate relationships with functional stability in young adults, with reported correlations around r = 0.38–0.40. This suggests toe strength may provide useful balance-related context, but it does not determine balance on its own.
• 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 toe flexion 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 and lesser-toe contribution 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 toe flexion 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 force production matters, such as sprinting, jumping, cutting or push-off tasks. 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 flexion force briefly and whether impulse improves while peak force stays similar.

Fatigue index
Use only if repeated or sustained toe flexion 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, calf strength, balance and general exercise goals.

Older adults
Consider balance, transfers, daily tasks, walking confidence, fatigue, rest periods and function. Toe strength may provide useful context for standing and walking tasks, but it should not be interpreted without functional assessment.

Athletes and sport clients
Consider sprinting, jumping, cutting, landing and push-off demands. Peak toe flexion 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 strength 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:

• Pressing with the whole forefoot instead of the toes
• Ankle plantarflexion 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 strength 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 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 Toe Flexion Strength Test may be useful for:

• Baseline foot strength assessment
• Side-to-side comparison
• Comparing 1st toe and lesser-toe contribution
• Monitoring response to exercise or intervention
• Supporting balance and gait assessment reasoning
• Reviewing push-off-related strength context
• Client education
• Comparing with calf strength, ankle strength, toe mobility and functional tests

Ideas to Make the Result Better

If force is low on both sides, consider assessing toe mobility, foot strength, calf capacity, balance, gait, footwear comfort and confidence with loading.

If one side is much lower, compare with symptoms, injury history, toe mobility, calf strength, ankle 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, calf raise capacity, 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: Toes relaxed or slightly extended, with the same start position used at retest
Joint or trunk angle: Record knee, ankle and 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 under or against the plantar surface of the toes, 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 Toe Flexion Strength Test measure?

It measures isometric toe flexion force output in a specific test setup.

Is this the same as 1st toe flexion?

Not always. Depending on placement, this test may measure combined toe flexion, lesser-toe flexion or a toe grip-style pattern. Record exactly which toes were tested.

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 toe flexion 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?

Published examples include hallux flexion around 32.0–142.4 N, with an average of 88.9 ± 29.8 N, and lesser-toe flexor strength around 0.95 ± 0.29 N/kg in one healthy young male sample. These are not direct Muscle Meter targets unless the protocol is closely matched.

Can this test diagnose a toe or foot condition?

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

What can make the result unreliable?

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

What should be recorded in Measurz?

Record side, foot position, toe start position, which toes were tested, device placement, peak force, percentage of body weight if directly calculated, symptoms, compensations, confidence, scoring method and related findings.

Key Takeaways

• The Ankle Toe Flexion Strength Test measures isometric toe flexion force output.
• Peak force is usually the main routine Muscle Meter metric.
• Published examples include hallux flexion force around 32.0–142.4 N, with an average of 88.9 ± 29.8 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

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

Słomka, K. J., & Michalska, J. (2024). Relationship between the strength of the ankle and toe muscles and functional stability in young, healthy adults. Scientific Reports, 14, 9125. https://doi.org/10.1038/s41598-024-59906-7

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

Xiao, S., Zhang, X., Deng, L., Zhang, S., Cui, K., & Fu, W. (2020). Relationships between foot morphology and foot muscle strength in healthy adults. International Journal of Environmental Research and Public Health, 17(4), 1274. https://doi.org/10.3390/ijerph17041274