Windlass Test: Difference between revisions

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== Definition/Description  ==


<span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size:11.0pt;line-height:105%"></span></span><span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size:11.0pt;line-height:105%"></span></span>
<!--StartFragment--> <span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size:11.0pt;line-height:105%">A
“windlass” is the tightening of a rope or cable.'''(1)'''</span></span>
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. (2)
<span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size:11.0pt;line-height:105%">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.<span style="mso-spacerun: yes">&nbsp;</span>The test can be important in the decision-making process involved in the evaluation and treatment of plantar fasciitis.</span></span>
<span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size:11.0pt;line-height:105%">A
positive windlass test: heel pain reproduced with passive dorsiflexion of the
toes.</span></span>
<span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size:11.0pt;line-height:105%"></span></span>
<div style="mso-element:endnote-list"><div style="mso-element:endnote" id="edn">
<span lang="EN-US">(</span>''<span lang="EN-US">1) Viel, E&nbsp;; Esnault M. The effect of increased tension in the</span>'' plantar fascia&nbsp;: a biomechanical analysis Physiother Practica 1989&nbsp;;5&nbsp;:69-73
</div><div style="mso-element:endnote" id="edn">
''<span lang="EN-US">(2) Lori A. Bolga; Terry R. Malone: Plantar fasciitis and the Windlass</span>'' Mechanism: A biomechanical link to Clinical Practice
</div> </div> <!--EndFragment-->


== Purpose of the test  ==
== Purpose of the test  ==

Revision as of 01:41, 21 December 2010

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Search Strategy[edit | edit source]

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Purpose of the test[edit | edit source]

The Windlass test is designed to detect presence of plantar fasciitis.

Positive test: A positive test is defined as reproduction of pain at the medical calcaneal tubercle.

Clinically Relevant Anatomy[edit | edit source]

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Performance of the test[edit | edit source]

Non-weight bearing: With the patient sitting, the clinician performs forceful great toe extension while stabilizing the ankle.

Weight bearing: With the patient in a weight bearing position, the clinician performs forceful great toe extension.

Diagnostic properties[edit | edit source]

Non-weight bearing:

Sensitivity: 0.18
Specificity: 0.99
Positive likelihood ratio: 16.21
Negative likelihood ratio: 0.82

Weight bearing:

Sensitivity: 0.33
Specificity: 0.99
Positive Likelihood Ratio: 28.70
Negative Likelihood Ratio: 0.68

Key Research[edit | edit source]

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Resources
[edit | edit source]

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[edit | edit source]

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Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

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