Manual Muscle Testing of the Toes

Motion	Patient Position	Start Position	End Position
MP Flexion of Great Toe	The patient is short sitting with legs hanging over the edge of the table. The ankle is in a neutral position. The therapist is seated on a stool in front of the patient. The test foot rests on the examiner's lap. The therapist stabilizes the dorsum of the foot just below the ankle with one hand, and uses the index finger of the other hand to resist beneath the proximal phalanx of the great toe. Then patient actively flexes the great toe.
IP Flexion of Great Toe	The patient is short sitting with legs hanging over the edge of the table. The ankle is in a neutral position. The therapist is seated on a stool in front of the patient. The test foot rests on the examiner's lap. The therapist stabilizes the dorsum of the foot just below the ankle with one hand, and uses the index finger and thumb of the other hand to grasp the distal phalanx of the great toe for resistance. Then patient actively flexes the great toe at the IP joint.
MP Flexion of Lesser Toes	The patient is short sitting with legs hanging over the edge of the table. The ankle is in a neutral position. The therapist is seated on a stool in front of the patient. The test foot rests on the examiner's lap. The therapist stabilizes the dorsum of the foot just below the ankle with one hand, and uses the index finger of the other hand to resist beneath the MP joints of the four lesser toes. Then patient actively flexes the toes at the MP joints, keeping the IP joints neutral.
PIP Flexion of the Lesser Toes	The patient is short sitting with legs hanging over the edge of the table. The ankle is in a neutral position. The therapist is seated on a stool in front of the patient. The test foot rests on the examiner's lap. The therapist uses both hands to grasp the anterior foot with the fingers across the dorsum of the foot and the thumbs under the proximal phalanges for resistance. Then patient actively flexes the toes at the PIP joints.
DIP Flexion of the Lesser Toes	The patient is short sitting with legs hanging over the edge of the table. The ankle is in a neutral position. The therapist is seated on a stool in front of the patient. The test foot rests on the examiner's lap. The therapist uses both hands to grasp the anterior foot with the fingers across the dorsum of the foot and the thumbs under the distal phalanges for resistance. Then patient actively flexes the toes at the DIP joints.
MP Extension of Great Toe	The patient is short sitting with legs hanging over the edge of the table. The ankle is in a neutral position. The therapist is seated on a stool in front of the patient. The test foot rests on the examiner's lap. The therapist stabilizes the metatarsal area by contouring hand around the plantar surface of the foot with the thumb curving around the base of the great toe. For resistance, place thumb over the MP joint. The other hand stabilizes the foot at heel. The patient actively extends MP joint.
IP Extension of Great Toe	The patient is short sitting with legs hanging over the edge of the table. The ankle is in a neutral position. The therapist is seated on a stool in front of the patient. The test foot rests on the examiner's lap. The therapist stabilizes the metatarsal area by contouring hand around the plantar surface of the foot with the thumb curving around the base of the great toe. For resistance, place thumb over the IP joint. The other hand stabilizes the foot at heel. The patient actively extends IP joint.
MP Extension of Lesser Toes	The patient is short sitting with legs hanging over the edge of the table. The ankle is in a neutral position. The therapist is seated on a stool in front of the patient. The test foot rests on the examiner's lap. The therapist uses both hands to stabilize the metatarsals with the fingers on the plantar surface and the thumbs on the dorsum of the foot. The patient actively extends MP joints of lesser toes.
PIP Extension of Lesser Toes	The patient is short sitting with legs hanging over the edge of the table. The ankle is in a neutral position. The therapist is seated on a stool in front of the patient. The test foot rests on the examiner's lap. The therapist uses one hand to stabilize 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 toes. The patient actively extends PIP joints.
DIP Extension of Lesser Toes	The patient is short sitting with legs hanging over the edge of the table. The ankle is in a neutral position. The therapist is seated on a stool in front of the patient. The test foot rests on the examiner's lap. The therapist uses one hand to stabilize 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 distal phalanges of toes. the patient actively extends DIP joints.

Adapted from:

Hislop, Helen J. & Montgomery, Jaqueline with contributor Barbara Connelly.

      Daniels and Worthingham's muscle testing: techniques of manual examination., 6th edition, 1995.