Windlass Test

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Definition

A “windlass” is the tightening of a rope or cable. 

The plantar fascia simulates a cable attached to the calcaneus and the metatarsophalangeal joints. Dorsiflexion during the propulsive phase of gait winds the plantar fascia around the head of the metatarsal. This winding of the plantar fascia shortens the distance between the calcaneus and metatarsals to elevate the medial longitudinal arch. The plantar shortening that results from dorsiflexion is the essence of the windlass mechanism principle.

The windlass mechanism is a mechanical model that describes the manner which plantar fascia supports the foot during weight-bearing activities and provides information regarding the biomechanical stresses placed on plantar fascia.  The test can be important in the decision-making process involved in the evaluation and treatment of plantar fasciitis

A positive windlass test: heel pain reproduced with passive dorsiflexion of the toes.

Purpose of the test

Windlass-test

is a test to determine plantar fascia abnormalities is terms of over- and underpronation. Such information is important clinically because it may provide healthcare professionals with a clear understanding bout the relationship between abnormalities and biomechanical influences.. 

The test achieves a direct stretch which can be effective in the treatment for plantar fasciitis.( diGiovanni et al., 2003,2006; Ross, 2002) For a tight plantar fascia stretch beyond the end range of motion is usually suggested to regain his proper flexibility. (Dogerty,1985) The direct stretch onto plantar fascia by dorsiflexing the toes were more desired than Achilles tendon stretch alone in treating plantar fasciitis. DiGiovanni et al. (2003,2006) discovered that fascia stretch group demonstrated less pain and achieved higher activity level.

Clinically Relevant Anatomy

The windlass mechanism occurs during terminal stance when the heel is off the ground. The windlass effecting acting trough the MTP joints with particular contribution from the first MTP joint.

During the terminal stance, as the soleus and de gastrocnemius muscles contract actively to lift the heel of the ground, extension occurs at the metatarsophalangeal joints. The plantar fascial bands envelops  the convex surface of the metatarsal heads producing the windlass effect.

It accumulates the tension in the plantar fascia, raises the longitudinal arc and tends to resist the posterior and superior rotation of the calcaneus.

Performance of the test

The difference between bearing weight and non-weight is that the sensibility is higher when the patient carries his weight.

Non-weight bearing position: 

Passively raise the toes of the patient while he/se is sitting to see whether this causes pain.

1.     Patient’s knee is flexed to 90° while in non-bearing position

2.     Examiner stabilized the ankle and extends the MTP joint while allowing the IP to flex (preventing motion limitations due to short hallucis longus)

3.     Patient is standing on a step stool with toes over the stool’s edge.

4.     MTP joint is extended while allowing IP joint to flex

5.     Positive test if pain was provocated at the end range of the MTP extension

Weight-bearing position

With the patient in a weight bearing position, the examiner creates a great toe extension

[[Image:|84611-86143-308tn.jpg]]Twenty-two patients with plantar fasciitis, 23 patients with other types of foot pain, and 30 patients in a control group were evaluated with the Windlass test performed in a weightbearing and non-weightbearing position. In the non-weightbearing test, the first MP joint was maximally dorsiflexed with the ankle stabilized. The weightbearing test was performed with the toes hanging off the edge of a stool and dorsiflexion of the first MP was performed. Seven of the 22 patients in the plantar fasciitis group had a positive weight bearing Windlass test (31.8%), while only three had a positive test result in a non-weightbearing position (13.6%). None of the patients in the other foot pain group or control group had pain in the weightbearing and non-weightbearing position.

Diagnostic 

The plantar fascia strain increases with the increment of toe dorsiflexion angle and also with the increment of the Achilles tendon forces.

 Regression analysis of clinical data indicates that changing the toe angles caused more fascia strain change than the change in the Achilles tendon force (100N). The weighted influence of toe dorsiflexion angles and Achilles tendon force was 66,14% and 33,86% comparing to Carlon’s paper 84,5% and 15,5% respectively. These statistical results corresponded to the findings from DiGiovanni et al. (2003,2006) that a direct stretch by dorsiflexing the toes contributed more plantar tension than the Achilles tendon stretch alone.

The valuate the effects of various combinations of toe dorsiflexion degree and Achilles tendon pulling force on plantar fascia response, the medial cuneiform and cuboids’ bones were fixed, and the at the top of the talus, only vertical movement was allowed. A total of 15 combinations were analyzed, with different toe dorsiflexion angles (15°, 30° and 45°) in combination with Achilles tension forces (100,200,300,400 and 500N).

After tests and X-ray the results showed that the maximum stress was concentrated near the medial calcaneal tubercle.

Backstorm and More also suggested stretching using a contract-relax-contract proprioreptive neuromuscular facilitation method.

Key Research

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Resources

Brown C. A review of subcalcaneal heel pain and plantar fasciitis. Aust Fam Physician. 1996;25:875–885.

De Garceau D, Dean D, Requejo SM, Thordarson DB. The association between diagnosis of plantar fasciitis and Windlass test results. Foot Ankle Int. 2003;24:251–255.

Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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