Great Toe Strength and Direct Assessment Methods: A Scoping Review for Clinical Applications

Great toe strength (GTS) is critical for gait, balance, and mobility, yet reliable assessment methods are lacking. This scoping review aims to evaluate and synthesize the direct methods of GTS assessment and their corresponding measurement protocols to guide clinical and research applications. Following the Joanna Briggs Institute methodology, five databases were searched: PubMed, CINAHL, Embase, Web of Science, and IEEE Xplore. All publications on or before 16 December 2024 were included in this review. Studies were included if they quantified isolated great toe strength in human participants using direct measurement tools with non-normalized force outcomes, while exclusion criteria included non-human models, indirect assessments (e.g., electromyography), and multi-digit or dynamic tasks. Following the initial screening of the results, the information from the included articles were extracted into Excel for analyses and synthesis. Two independent reviewers screened titles/abstracts and full texts using Covidence. Conflicts were resolved via consensus or consultation with a third reviewer. We identified 55 studies involving 2821 participants that met our inclusion criteria. Four types of direct GTS assessment methods were identified: dynamometry (56%), manual muscle testing (11%), force transducers (13%), and load cells/strain gauges (18%). Dynamometry was the most common but showed variable reliability due to non-standardized protocols. Healthy individuals exhibited higher GTS (95.01 N) than those with conditions like hallux injury (6.1 N), though plantar fasciitis/plantar heel pain populations showed unexpectedly high GTS (133.27 N). No clear age-related GTS trend emerged, likely due to methodological variability. Less than 11% of studies measured extension strength, highlighting a critical research gap. This review emphasizes the need for standardized protocols to enhance GTS assessment reliability and clinical utility.