Windlass Test: Difference between revisions
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<span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size:11.0pt;line-height:105%">The | <span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size:11.0pt;line-height:105%">The | ||
difference between bearing weight and non-weight is that the sensibility is | difference between bearing weight and non-weight is that the sensibility is | ||
higher when the patient carries his weight.</span></span><ref name="Plantar fasciitis: evidence-based review of diagnosis and therapy">[i] Cole C, Seto C, Gazewood J,Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physican. 2005;73(11);2237-2242,2247-2248.</ref> | higher when the patient carries his weight.</span></span><ref name="Plantar fasciitis: evidence-based review of diagnosis and therapy">[i] Cole C, Seto C, Gazewood J,Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physican. 2005;73(11);2237-2242,2247-2248.</ref> | ||
<span class="MsoIntenseReference"><u style="text-underline:thick"><span lang="EN-US" style="font-size:10.0pt; | <span class="MsoIntenseReference"><u style="text-underline:thick"><span lang="EN-US" style="font-size:10.0pt; mso-bidi-font-size:11.0pt;line-height:105%">Non-weight bearing position: </span></u></span><ref name="Pocket Orthopaedics: Evidence-Based Survival Guide">Michael Wong: Pocket Orthopaedics: Evidence-Based Survival Guide pg 361</ref> | ||
mso-bidi-font-size:11.0pt;line-height:105%">Non-weight bearing position: </span></u></span><ref name="Pocket Orthopaedics: Evidence-Based Survival Guide">Michael Wong: Pocket Orthopaedics: Evidence-Based Survival Guide pg 361</ref> | |||
<span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size:11.0pt;line-height:105%">Passively | <span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size:11.0pt;line-height:105%">Passively | ||
raise the toes of the patient while he/se is sitting to see whether this causes | raise the toes of the patient while he/se is sitting to see whether this causes | ||
pain. | pain.</span></span> | ||
<span class="MsoIntenseReference"><span lang="EN-US | <span class="MsoIntenseReference"><span lang="EN-US"><span style="mso-list:Ignore">1.<span> </span></span></span></span><span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size: 11.0pt;line-height:105%">Patient’s knee is flexed to 90° while in non-bearing | ||
position</span></span> | |||
11.0pt;line-height:105%">Patient’s knee is flexed to 90° while in non-bearing | |||
position | |||
<span class="MsoIntenseReference"><span lang="EN-US | <span class="MsoIntenseReference"><span lang="EN-US"><span style="mso-list:Ignore">2.<span> </span></span></span></span><span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size: 11.0pt;line-height:105%">Examiner stabilized the ankle and extends the MTP | ||
11.0pt;line-height:105%">Examiner stabilized the ankle and extends the MTP | |||
joint while allowing the IP to flex (preventing motion limitations due to short | joint while allowing the IP to flex (preventing motion limitations due to short | ||
hallucis longus) | hallucis longus)</span></span> | ||
<span class="MsoIntenseReference"><span lang="EN-US | <span class="MsoIntenseReference"><span lang="EN-US"><span style="mso-list:Ignore">3.<span> </span></span></span></span><span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size: 11.0pt;line-height:105%">Patient is standing on a step stool with toes over the | ||
stool’s edge.</span></span> | |||
11.0pt;line-height:105%">Patient is standing on a step stool with toes over the | |||
stool’s edge. | |||
<span class="MsoIntenseReference"><span lang="EN-US | <span class="MsoIntenseReference"><span lang="EN-US"><span style="mso-list:Ignore">4.<span> </span></span></span></span><span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size: 11.0pt;line-height:105%">MTP joint is extended while allowing IP joint to flex</span></span> | ||
11.0pt;line-height:105%">MTP joint is extended while allowing IP joint to flex | |||
<span class="MsoIntenseReference"><span lang="EN-US | <span class="MsoIntenseReference"><span lang="EN-US"><span style="mso-list:Ignore">5.<span> </span></span></span></span><span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size: 11.0pt;line-height:105%">Positive test if pain was provocated at the end range | ||
of the MTP extension</span></span> | |||
11.0pt;line-height:105%">Positive test if pain was provocated at the end range | |||
of the MTP extension | |||
< | <br> | ||
<span class="MsoIntenseReference"><u style="text-underline:thick"><span lang="EN-US" style="font-size:10.0pt; | <span class="MsoIntenseReference"><u style="text-underline:thick"><span lang="EN-US" style="font-size:10.0pt; mso-bidi-font-size:11.0pt;line-height:105%">Weight-bearing position</span></u></span> | ||
mso-bidi-font-size:11.0pt;line-height:105%">Weight-bearing position</span></u | |||
<span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size:11.0pt;line-height:105%">With | <span class="MsoIntenseReference"><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size:11.0pt;line-height:105%">With | ||
the patient in a weight bearing position, the examiner creates a great toe | the patient in a weight bearing position, the examiner creates a great toe | ||
extension | extension</span></span> | ||
<br> | |||
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o:title="84611-86143-308tn.jpg"/> | o:title="84611-86143-308tn.jpg"/> | ||
<v:textbox style='mso-rotate-with-shape:t'/> | <v:textbox style='mso-rotate-with-shape:t'/> | ||
</v:shape><![endif]--><span style="mso-ignore:vglayout;position: | </v:shape><![endif]--><span style="mso-ignore:vglayout;position: absolute;z-index:-1;left:0px;margin-left:261px;margin-top:226px;width:202px; height:152px">[[Image:|84611-86143-308tn.jpg]]</span><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size:12.0pt;line-height:105%; mso-bidi-font-family:Arial">Twenty-two patients with plantar fasciitis, 23 | ||
absolute;z-index:-1;left:0px;margin-left:261px;margin-top:226px;width:202px; | |||
height:152px">[[Image:|84611-86143-308tn.jpg]]</span><span lang="EN-US" style="font-size:10.0pt;mso-bidi-font-size:12.0pt;line-height:105%; | |||
mso-bidi-font-family:Arial">Twenty-two patients with plantar fasciitis, 23 | |||
patients with other types of foot pain, and 30 patients in a control group were | 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 | evaluated with the Windlass test performed in a weightbearing and | ||
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positive test result in a non-weightbearing position (13.6%). None of the | 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 | patients in the other foot pain group or control group had pain in the | ||
weightbearing and</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt; | weightbearing and</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt; line-height:105%;mso-bidi-font-family:Arial"> non-weightbearing position.</span><ref name="The association between diagnosis of plantar fasciitis and Windlass test results">De Garceau D, Dean D, Requejo SM, Thordarson DB: The association between diagnosis of plantar fasciitis and Windlass test results. Foot Ankle Int. 2004 Sep;25(9):687</ref> | ||
line-height:105%;mso-bidi-font-family:Arial"> non-weightbearing position.</span><ref name="The association between diagnosis of plantar fasciitis and Windlass test results">De Garceau D, Dean D, Requejo SM, Thordarson DB: The association between diagnosis of plantar fasciitis and Windlass test results. Foot Ankle Int. 2004 Sep;25(9):687</ref> | |||
<div style="mso-element:endnote-list"><br></div> | <div style="mso-element:endnote-list"><br></div> | ||
== Diagnostic properties == | == Diagnostic properties == |
Revision as of 12:39, 18 January 2011
Original Editor - Alesha Walker, Bilitis Crokaert
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Search Strategy[edit | edit source]
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Purpose of the test[edit | edit source]
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.. [1]
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. [2]
Clinically Relevant Anatomy[edit | edit source]
The windlass mechanism occurs during terminal stance when the heel is off the ground.[3] 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.
<o:p></o:p> It accumulates the tension in the plantar fascia, raises the longitudinal arc and tends to resist the posterior and superior rotation of the calcaneus.[4]
Performance of the test[edit | edit source]
The difference between bearing weight and non-weight is that the sensibility is higher when the patient carries his weight.[5]
Non-weight bearing position: [6]
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.[7]
Diagnostic properties[edit | edit source]
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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- ↑ Lori A. Bolga; Terry R. Malone: Plantar fasciitis and the Windlass Mechanism: A biomechanical link to Clinical Practice
- ↑ Hsin-YI Kathy Cheng, Chun-Li Lin, Hsein-Wen Wang, Shih-Wei Chou; Finite element analysis of plantar fascia under stretch- the relative contribution of windlass mechanism and achilles tendon force. Journal of Biomechanics 41 (2008) 1937-1944
- ↑ Hicks JH. The mechanics of the foot. The plantar aponeurosis and the Arch. J Anat 1954;88: 25-30 Sarrafian SK, Functional characteristics of the foot and plantar aponeurosis under tibio-talar loading. Foot Ankle 1987;8(1): 4-18
- ↑ Gary C Hunt, Tom Sneed, Herb Hamann, Sheldon Chisam: Biomechanical and histiological considerations for devolpment of the plantar fasciitis and evaluation of arch taping as a treatment option the control associated plantar heel pain: a single-subject design
- ↑ [i] Cole C, Seto C, Gazewood J,Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physican. 2005;73(11);2237-2242,2247-2248.
- ↑ Michael Wong: Pocket Orthopaedics: Evidence-Based Survival Guide pg 361
- ↑ De Garceau D, Dean D, Requejo SM, Thordarson DB: The association between diagnosis of plantar fasciitis and Windlass test results. Foot Ankle Int. 2004 Sep;25(9):687