International normative values for the weight-bearing lunge test across age and sex in 899 healthy adults

Musculoskelet Sci Pract. 2026 Apr:82:103525. doi: 10.1016/j.msksp.2026.103525. Epub 2026 Feb 20.

Abstract

Background: Ankle dorsiflexion is essential for lower extremity function and limitations in this motion are associated with musculoskeletal injury and decreased performance during functional tasks. The distance-based weight-bearing lunge test (WBLT) is a reliable and valid clinical measure of ankle dorsiflexion, yet normative data across age and sex are lacking.

Objectives: To establish adult age- and sex-specific normative values for the distance-based WBLT.

Design: Cross-sectional, multi-country observational study.

Method: A total of 899 adults from Canada, Spain, and Iran completed demographic and clinical measures including height, Foot Posture Index (FPI-6), supination resistance, and bilateral WBLT performance using a standardized knee-to-wall protocol. Participants were stratified into seven age groups and by sex. Between-limb differences were examined with paired t-tests. Associations between WBLT and height, FPI-6, and supination resistance were assessed using Pearson correlations. Age and sex effects were evaluated using two-way ANOVA with Bonferroni-adjusted comparisons. Percentile-based clinical categories were generated for each age-sex subgroup.

Results/findings: No meaningful difference was observed between limbs (p = 0.172, d = 0.05). WBLT performance declined progressively with age (p < 0.001, η2 = 0.283), with greater reductions evident beginning in the 60-69 age group. Males demonstrated slightly greater dorsiflexion than females across age groups (p = 0.003, η2 = 0.010). Height, FPI-6, and supination resistance showed small, non-clinically meaningful associations with WBLT scores (R2 ≤ 0.09).

Conclusions: This study provides robust age- and sex-specific normative values for the distance-based WBLT, improving clinical interpretation of weight-bearing ankle dorsiflexion across the adult lifespan.

Keywords: Ankle; Biomechanical phenomena; Foot; Physical examination; Podiatry.

Publication types

  • Observational Study
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Ankle Joint* / physiology
  • Canada
  • Cross-Sectional Studies
  • Female
  • Healthy Volunteers
  • Humans
  • Iran
  • Male
  • Middle Aged
  • Range of Motion, Articular* / physiology
  • Reference Values
  • Sex Factors
  • Spain
  • Weight-Bearing* / physiology
  • Young Adult