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Dsouza C J, Rebello S R, Ashraf M, Alankar A S, Lewis C P, Mendonca G A. Toe Grip Strength and Its Relationship With Balance and Mobility in Knee Osteoarthritis: Implications for Physical Therapy Assessment and Intervention. PTJ 2026; 16 (4) :453-464
URL: http://ptj.uswr.ac.ir/article-1-793-en.html

Purpose: Knee osteoarthritis (OA) is a leading cause of pain, impaired mobility, and reduced functional independence among older adults. Altered foot biomechanics, particularly impaired hallux function, may influence lower-limb kinematics and contribute to deficits in balance and mobility. Toe grip strength (TGS), an indicator of intrinsic foot muscle function, has received limited attention in individuals with knee OA. This study aimed to determine the relationship between TGS, dynamic balance, and functional mobility in patients with knee OA.
Methods: A cross-sectional study was conducted among 147 adults aged 45–75 years with Kellgren–Lawrence grade 2 knee OA and symptoms persisting for more than three months. TGS was measured using a pinch gauge dynamometer. Dynamic balance and mobility were assessed using the functional reach test (FRT) and timed up and go (TUG) test, respectively. Pain intensity was evaluated using the visual analog scale (VAS), while self-reported knee function was assessed using the western ontario and mcmaster universities osteoarthritis index (WOMAC). Associations between variables were examined using Spearman’s rank correlation. Linear and multiple regression analyses were performed to determine the predictive value of balance and mobility measures after adjusting for age, body mass index, and OA duration.
Results: TGS demonstrated a strong positive correlation with FRT (r=0.942, P<0.001) and a strong negative correlation with TUG performance (r=–0.832, P<0.001), indicating that greater TGS was associated with better balance and faster functional mobility. These associations remained significant after controlling for potential confounding variables. Linear regression analysis showed that FRT explained 91.3% of the variance in TGS, whereas TUG explained 74.0%. In the multiple regression model (R²=0.922), FRT emerged as the strongest independent predictor of TGS. No significant associations were identified between TGS and either VAS pain scores or WOMAC scores.
Conclusion: TGS is strongly and independently associated with dynamic balance and functional mobility in patients with knee OA. These findings suggest that TGS may serve as a practical clinical marker of lower-limb functional performance and a potential rehabilitation target. However, TGS does not appear to reflect pain intensity or patient-reported knee disability in this population.