Dorsiflexion of the great toe (active)

Name of test

Dorsiflexion of the great toe test

What it tests

Deep peroneal nerve, L5 nerve root, and extensor hallucis longus muscle and tendon integrity.

How to do it

The patient sits on the exam table with their leg resting off the edge.

The examiner places a finger on the great toe (red arrow). The patient is asked to dorsiflex the great toe (black arrow) as the examiner resists and assesses the strength of this motion with the finger.

The normal response

The great toe should dorsiflex with a significant amount of strength and the examiner should not be able to oppose this motion easily.

What it means if not normal

The common causes of great toe dorsiflexion weakness are a peroneal nerve palsy or an L5 radiculopathy. Thus, if the patient cannot actively extend the toe, first passive motion should be assessed (to make sure that the joint functions) and then the patient should be asked to actively extend the ankle (to invoke an action powered by a different lumbar root and different muscle).

A failure to actively extend the ankle at the same time is a sign of a peroneal nerve palsy; an isolated toe problem suggests an L5 radiculopathy

Comments

If you are concerned that MTP pain with maximal extension is inhibiting this motion, you can test fuction this starting in maximal plantar flexion (second figure). In that instance, you must feel the quality (strength) of the motion, as the toe has a tendency to “bounce back” to neutral even without active extension.

Citations

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