Test: Hallux and Toe MP and IP Extension

Video Link

Background/Purpose

Many patients cannot separate great toe extension from extension of the four lateral toes. Nor can most separate MP from IP activity. The test is used not so much to ascertain strength as to determine whether the toe muscles are active.

Procedure

Position of patient: Short sitting with foot on examiner's lap. Alternate position: supine. Ankle in neutral (midway between plantar and dorsiflexion).
Position of clinician: Sitting on low stool in front of the patient, or standing beside the exam table near the patient's foot.
Instructions to the patient: "Straighten your big toe. Hold it." "Straighten your toes and hold it."
Performed: Unilaterally

Dialog

Lateral toes: One hand stabilizes the metatarsals with the fingers on the plantar surface and the thumb on the dorsum of the foot. The other hand is used to give resistance with the thumb placed over the dorsal surface of the proximal phalanges of the toes. Hallux: Stabilize the metatarsal area by contouring hand around the plantar surface of the foot with the thumb curving around to the base of the hallux. The other hand stabilizes the foot at the heel. For resistance, place the thumb over the MP joint or over the IP joint. Patient extends lateral four toes or extends hallux.

Criteria

• Grade 5 Normal and 4 (Good): Patient can extend the toes fully against variable resistance.
• Grade 3 (Fair) and 2 (Poor): Patient can complete range of motion with no resistance or can complete a partial range of motion.
• Grades 1 (Trace) and 0 (Zero): Tendons of the extensor digitorum longus can be palpated or observed over dorsum of metatarsals. Tendon of the extensor digitorum brevis often can be palpated on the lateral side of the dorsum of the foot just in front of the malleolus. Palpable contractile activity is a Grade 1; no contractile activity is a Grade 0.

Measurement

LOINC Code

0

Scale/Grading

Pass/Fail