Is Toe Strength an Overlooked Marker of Aging and Longevity?
For years, researchers and clinicians have searched for simple, accessible tests that can reflect overall health, resilience, and aging. The logic is straightforward: if a single measurement reliably tracks physical decline, it gives us an early warning signal and a target for intervention.
One test has stood out more than most.
Grip strength.
Handgrip strength has been repeatedly linked to mortality risk, cardiovascular health, functional independence, and overall longevity. It is easy to measure, inexpensive, and surprisingly predictive.
But recent research suggests we may be overlooking another critical marker of aging. One that sits much closer to how humans actually move through the world.
Toe strength.
A 2022 study published in the Journal of Foot and Ankle Research raises an important question:
What if toe grip strength declines earlier than handgrip strength, and what if that matters more than we think?
The Study: Toe Grip Strength Declines Earlier Than We Expect
Miura et al. (2022) examined strength changes across different muscle groups in community-dwelling older adults. Specifically, they compared:
Toe grip strength
Handgrip strength
Knee extension strength
Their goal was to understand which physical qualities decline first with age, not just which ones decline the most.
Key Findings
Toe grip strength declined earlier than both handgrip and knee extension strength, particularly in men.
The decline occurred at an estimated rate of ~8% per decade.
By their 60s, individuals who did not actively train foot strength showed roughly 30% lower toe strength compared to their 20s.
Handgrip strength showed significant decline later, primarily in the oldest age groups.
Knee extension strength showed relatively less age-related decline in this cohort.
Why This Matters
Most aging research focuses on large, proximal muscle groups or easily measured variables. This study suggests that distal strength, particularly in the foot, may act as an earlier signal of neuromuscular decline.
That has major implications for balance, fall risk, and long-term independence.
Why Grip Strength Became a Gold Standard for Longevity
Before diving deeper into toe strength, it’s important to understand why grip strength earned its reputation in the first place.
Multiple large-scale studies have shown that low grip strength is associated with:
Increased all-cause mortality
Higher cardiovascular disease risk
Poorer functional outcomes
Greater hospitalization risk
Some research has even suggested that grip strength may be a stronger predictor of mortality than systolic blood pressure in certain populations.
Why?
Because grip strength is not just about the hand.
It reflects:
Overall muscle mass
Neurological integrity
Nutritional status
Training history
Systemic health
Grip strength became popular because it acts as a proxy for total body capacity.
But that doesn’t mean it’s the only proxy worth paying attention to.
Toe Strength: The Anatomy and Physiology We Ignore
If grip strength reflects upper-extremity capacity, toe strength reflects something more foundational.
What Toe Grip Strength Represents
Toe grip strength primarily involves:
The intrinsic foot muscles (lumbricals, interossei)
The long toe flexors (flexor hallucis longus, flexor digitorum longus)
Neural control at the ankle and foot
Sensory feedback critical for balance and coordination
These muscles are small, but they play an outsized role in:
Maintaining balance
Controlling the center of mass
Stabilizing during gait
Absorbing and transmitting force during running and jumping
Preventing slips and trips
Unlike grip strength, which is often trained indirectly through daily tasks or resistance training, toe strength is rarely challenged in modern life.
Shoes, supportive footwear, flat surfaces, and seated lifestyles all reduce the demand placed on the foot.
From a physiological standpoint, that makes toe strength particularly vulnerable to early decline.
Why This Matters for Bipedal Humans
Humans are bipedal organisms. Our entire movement system is organized around standing, walking, running, and navigating the environment on two feet.
The foot is not just another body part.
It is the interface between the body and the ground.
From a functional perspective:
Grip strength helps you interact with objects.
Toe and foot strength help you interact with gravity.
Balance, gait efficiency, and fall prevention all depend on how well force is managed at the foot.
So it makes intuitive sense that early declines in foot strength could precede visible declines elsewhere.
If the foundation weakens, the system compensates.
And compensation often shows up later as pain, instability, or injury.
Our Perspective at Zero Point One Physical Therapy
We think this research is compelling. But it needs context.
First: This Reinforces a Bigger Principle
Everything in the body exists on a continuum.
Whatever we don’t train, we lose.
Toe strength, grip strength, hip strength, aerobic capacity, balance, power. None of these exist in isolation. They rise and fall based on exposure, demand, and consistency.
The takeaway is not:
“Toe strength matters more than grip strength.”
The takeaway is:
Neglect shows up first where demand is lowest.
In modern life, that is often the foot.
Second: Measurement Matters
One reason grip strength became so popular is because it is:
Easy to measure
Reliable
Accessible via a handheld dynamometer
Toe strength is harder to assess accurately. It often requires specialized equipment or indirect testing, which limits its widespread use in clinical and research settings.
That doesn’t make it less important.
It just makes it less convenient.
And convenience often drives what gets studied and emphasized.
What This Means for Longevity and Training
From a longevity and performance standpoint, this research reinforces several key ideas:
Foot strength is not optional
If you want to walk, run, train, and stay independent as you age, your feet must be capable of handling load.Early decline does not mean inevitable decline
Muscle and connective tissue adapt to stimulus at every age. Decline reflects underuse, not destiny.No single metric defines health
Grip strength, toe strength, blood pressure, VO₂ max. These are indicators, not verdicts.Foundational strength supports everything else
Strong feet support better balance, more confident movement, and safer exposure to higher-level activities.
Practical Takeaway
Toe strength is not a novelty metric.
It is a reflection of how well your foundation is being challenged.
At Zero Point One Physical Therapy, we view the body as an integrated system. We do not chase single numbers or isolated tests. We focus on capacity, from the ground up.
That includes:
Strength
Balance
Tissue tolerance
Movement confidence
Progressive exposure to real-world demands
Longevity is not built by optimizing one variable.
It is built by training the whole system consistently, especially the parts modern life tends to neglect.
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