Too Many Toes Sign Special Test

What is it used for?

• Assessing for hyperpronation (flatfoot) and tibial torsion.
• Identifying dysfunction of the posterior tibial tendon.

How to Perform

• Position: Have the patient stand comfortably while facing away from you.
• Observation: Look at the patient's feet from directly behind.
• Count: Observe how many toes are visible on the outer (lateral) side of the heel.

Interpretation of Results

• Normal: Only the fifth toe and part of the fourth toe are visible.
• Positive: Seeing more than two toes (e.g., 3 or 4) indicates the heel is in valgus and the forefoot is abducted (flattened).

References

• Magee, D. J. (2021). Orthopedic Physical Assessment (7th ed.). Elsevier.
• Miller, M. D. (2020). Miller's Review of Orthopaedics (8th ed.). Elsevier.