1st MTP Joint Extension Evaluation

Clinically, the importance of full functional extension of the ?big toe? is often underestimated.

Normal gait requires approximately 60�-70� of 1st MTP joint extension during the push off phase. If there is insufficient extension mobility at the 1st MTP joint, the push off will occur on an abducted foot, which can result in various clinical consequences.

Step #1: With the patient in ?natural? standing, passively lift up their ?big toes?.

Step #2: With the patient still in standing, manually laterally rotate the tibia through the calf muscles. This should supinate the subtalar joint and increase the height of the medial longitudinal arch.
Once again attempt to passively lift the ?big toe? off the ground. (Normal is 60-70 degrees)

Note if a difference in ROM exists in step #1 and #2. There is often a significant increase in 1st MTP joint extension mobility once the foot is supinated.

This may be due to the fact that tension on the plantar fascia is decreased allowing the big toe to extend further.

So What??

Basically if an asymmetry in 1st MTP joint extension is noted in either Step #1 or in Step #2, the joint should be considered ?abnormal? and should be mobilized.

Posted on: August 18, 2002


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