Foot Tapping Test (FTT)

The Foot Tapping Test (FTT) is a clinical test that can be used to assess upper motor neuron function and mobility impairment with aging. The test is simple to use and is performed with the patient sitting in a chair and the feet resting on the floor.

The ability to do rapid tapping movements of the fingers and foot decline with age and with the development of neuromotor diseases. Rapid finger tapping is frequently used to track the progression of diseases impacting the upper motor neurons, however the foot tapping test is used less frequently. Some authors have suggested that the test is an underutilized neurological assessment tool. The Foot Tapping Test requires the rapid activation and deactivation the foot dorsiflexor muscles and the decline in the speed that this happens at is a predictor for a decline in gait speed.

For the Foot Tapping Test, participants are seated with the foot on the floor, generally barefoot and are asked to tap their forefoot on the ground as rapidly as possible for 10 seconds while keeping the heel on the ground. Some clinicians do the test with the shoes still on. The number of taps are counted during the 10 seconds.

Some research studies use a force platform or specially constructed device with a ‘button’ connected to an electronic counter to tap the foot on to better record the number of taps; other research studies have used videos and the taps can be more accurately counted on slow-motion replay. For research purposes the test may be repeated 3 or more times with rests between trials and the average used for any analysis.

The foot tap speed is lower in those who have conditions such as those affecting the central motor system like cervical myelopathy, multiple sclerosis, Parkinsons’ disease and amyotrophic lateral sclerosis. The test has been shown to be correlated with mobility impairment due to aging changes so does have the potential to identify those at risk for mobility impairment issues. Periodic use of the test can be used to monitor and document the progress of mobility impairment as well as the response to interventions.

Pribble et al (2021) reported that the foot-tapping test exhibits a high test reliability, day-to-day reliability, and inter-rater reliability. Hinman (2019) showed that there is slightly more taps in the dominant vs non-dominant limb.

Research on the Foot Tapping Test:

Pribble et al (2021)"The foot-tapping test (FTT) exhibits a high test reliability, day-to-day reliability, and inter-rater reliability."
Tanigawa et al (2017)"We observed that finger and foot tapping can differentiate relapsing–remitting multiple sclerosis and progressive multiple sclerosis in a cross-sectional study and can also measure yearly and two-year disease progression in the latter"
Bobić et al (2018)"In this paper, we analyzed the data recorded by gyroscope mounted on a foot bridge during the foot tapping test (FTT). The data was collected from 17 healthy controls, 17 patients with PD and 17 patients with Multiple System Atrophy (MSA)"
Gunzler et al (2009)"Alternate foot tapping was equally reliable but more valid than finger tapping. Alternate foot tapping correlated better did existing Parkinson Disease outcome measures than did repetitive foot tapping. Foot tapping may be a useful outcome measure for determination of dopaminergic medication effect in Parkinson Disease clinical trials."
Speedtsberg et al (2017)"The results indicate that FastTap could have potential as a clinical assessment of ankle coordination in children with cerebral palsy."
Enoki et al (2019)"The number of 10-sec foot tapping in the patient group significantly correlated with the Nurick grades (r = −0.566; P < 0.0001), the JOA scores (r = 0.520; P < 0.0001), and the grip-and-release rates (r = 0.609; P < 0.0001). It also significantly correlated with the 30-m walking time (r = −0.507; P < 0.0001) and the number of steps taken (r = −0.494; P < 0.0001). "
Numasawa et al (2012)"The FTT results correlated with those of other tests for cervical myelopathy, and the FTT scores were improved by surgery. The FTT is an easy and useful quantitative assessment method for lower extremity motor function in patients with cervical myelopathy, especially those who cannot walk"
Hinman (2019)"This study demonstrates the moderate effect that normal aging has on foot-tap speed and provides normal values that clinicians may use as a reference when testing individuals with various neurological pathologies. However, the moderate correlation found between reaction time and foot taps suggests that these tests do not necessarily measure the same psychomotor attribute."
Kobayashi et al (2024)" The FTT is a valuable tool for the early detection of lower limb motor dysfunction in lumbosacral radiculopathy, particularly for L5 nerve root impairment."

External Links:
Foot Tapping Test (Podiatry Arena)

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