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1000 Norms Project: understanding foot and ankle health, disease and normality

A primary goal of healthcare is to understand the boundaries of health and normality and identify when abnormalities are harmful. Diagnosis of disease or impairment is often made by comparing results from clinical measures with healthy reference values. At present there is a great need for comprehensive lower limb reference data representing the healthy population. The 1000 Norms Project is currently recruiting to provide reference values for a set of widely-used clinical and biomechanical measures of the foot and ankle. A volunteer sample of 1000 healthy individuals between the ages of 3 and 100 years is participating in the Project. Measures of plantar pressure, gait, ankle range of motion, foot and ankle muscle strength, foot posture and ankle instability are included in the comprehensive battery of items (Table 1).

Table 1 Foot and ankle items assessed in the 1000 Norms Project

The 1000 Norms Project reliability study was completed in November 2013. Inter-rater reliability was found to be excellent (ICC>.75) for all foot and ankle measures (Table 2). Recruitment and data collection will take place over the next two years. The release of the final database to the international community via a secure, free online network is anticipated to occur in March 2016. The 1000 Norms Project will provide a substantial contribution to our understanding of the range of normal foot and ankle function in healthy individuals. The reference dataset will be a useful tool for disease diagnosis and management, health surveillance and future outcome measure development for clinical trials of rehabilitative, surgical and pharmacological interventions.

Table 2 Inter-rater reliability of foot and ankle items assessed in the 1000 Norms Project

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Correspondence to Jennifer N Baldwin.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Baldwin, J.N., McKay, M.M., Hiller, C.E. et al. 1000 Norms Project: understanding foot and ankle health, disease and normality. J Foot Ankle Res 7 (Suppl 1), A6 (2014).

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