Ankle & Foot
Muscle & Tendon
Evidence: suggestive
Paper Grip Test Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Testing the strength of the intrinsic muscles of the foot (toe plantar flexion).
- Screening for intrinsic muscle weakness (e.g., in diabetic neuropathy or claw toe deformity).
How to Perform
- Position: Patient sits with the foot flat on the floor.
- Action: Place a piece of paper (or business card) under the patient's toes.
- Command: Ask the patient to curl their toes to grip the paper while you try to pull it away.
Interpretation of Results
- Positive Test: Inability to hold the paper (weakness) compared to the uninjured side.
Clinical Context & Limitations
The Paper Grip Test should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Ankle & Foot region, combining the Paper Grip Test with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment (7th ed.). Elsevier.
