This lays the groundwork for developing new screening tools to detect the weakening of foot and ankle musculature and enhance fall risk assessment in people. The paper-grip test assesses hallux grip strength but is operator-dependent. To improve this, we propose an enhanced version called the EPGT that quantifies the continuous pulling force needed to remove a card from under the hallux. The EPGT force reliably and accurately measures hallux grip strength, which closely correlates with overall foot and ankle muscle strength and balance ability. By providing an objective measure of muscular decline, the EPGT could enable better monitoring of weakness in clinical settings and augmentation of fall risk prediction. 

Falls present a major health concern for older adults, with high rates of injury and recurrence highlighting the vital need for effective prevention. While multifaceted preventative interventions combining exercise, education, and home modifications have proven successful, screening tools to identify at-risk individuals are lacking, especially for use in community and primary care settings.  

Lower limb muscle weakness is a key risk factor for falls, but current tools lack quantitative strength measurements. The enhanced paper grip test (EPGT) that measures hallux strength shows promise as a screening tool, but it still requires further validation in varying settings and clinical conditions.