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| '''Original Editor '''- [[User:Alesha Walker|Alesha Walker]], [[User:Bilitis Crokaert|Bilitis Crokaert]] | | '''Original Editor '''- [[User:Alesha Walker|Alesha Walker]] as part of the [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]. |
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| '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} |
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| | == Description == |
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| | This windlass mechanism is a mechanical model that describes the manner in which plantar fascia supports the foot during weight-bearing activities and provides information regarding the biomechanical stresses placed on plantar fascia<ref name="Bolgla">Bolgla LA, Malone TR. Plantar fasciitis and the windlass mechanism: a biomechanical link to clinical practice. Journal of athletic training. 2004 Jan 1;39(1):77.</ref>. |
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| == Definition ==
| | The windlass test achieves a direct stretch on the plantar aponeurosis which can be effective in examining dysfunction of the plantar fascia. The test can be important in the decision-making process involved in the evaluation and treatment of [[Plantarfasciitis|plantar fasciitis]]. |
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-style: normal; font-size: 10pt; font-weight: normal; mso-bidi-font-weight: bold; mso-bidi-font-style: italic; mso-bidi-font-size: 11.0pt">A “windlass” is the tightening of a rope or cable. <ref name="Viel">Viel, E ; Esnault M., The effect of increased tension in the plantar fascia : a biomechanical analysis, Physiother Practica 1989 ;5 :69-73.</ref></span></span>
| | == The Windlass Mechanism == |
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-style: normal; font-size: 10pt; font-weight: normal; mso-bidi-font-weight: bold; mso-bidi-font-style: italic; mso-bidi-font-size: 11.0pt">During the swing phase in the [[Gait Cycle|gait cycle]], there is about 30 to 40 degrees of extension at MTP joints to prevent the toes stubbing the ground.<ref name="Reid" /> At the terminal part of the stance phase, as the heel lifts extension is achieved at the MTP joints depending on the individuals flexibility.<ref name="Reid">Reid C.D. et al., Sports Injury Assessment and Rehabilitation, 1st edition, Churchill Linvingstone, 1992, 130-131.</ref> The plantar fascia simulates a cable attached to the calcaneus and the metatarsophalangeal joints.<ref name="maf" /><ref name="Lori">Lori A. Bolga and Terry R. Malone: Plantar fasciitis and the Windlass Mechanism: A biomechanical link to Clinical Practice, J. Athl. Train., 2004,77-82.</ref> 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.<ref name="maf" /><ref name="Lori">Lori A. Bolga and Terry R. Malone: Plantar fasciitis and the Windlass Mechanism: A biomechanical link to Clinical Practice, J. Athl. Train., 2004,77-82.</ref></span></span> This mechanism creates a dynamic stable arch and hence a more rigid level for push off. <ref name="maf">Maffuli N. et al.Tndon injuries: basic science and clinical medicine, London, Springer Verlag, 2005.</ref>
| | Hicks<ref name="Hicks">Hicks JH. The mechanics of the foot, II: the plantar aponeurosis and the arch. J Anat. 1954;88:25–30</ref> originally described the foot and its ligaments as an arch-like triangular structure or truss. The calcaneus, midtarsal joint, and metatarsals (the medial longitudinal arch) formed the truss's arch. The plantar fascia formed the tie-rod that ran from the calcaneus to the phalanges. Vertical forces from body weight travel downward via the tibia and tend to flatten the medial longitudinal arch. Furthermore, ground reaction forces travel upward on the calcaneus and the metatarsal heads, which can further attenuate the flattening effect because these forces fall both posterior and anterior to the tibia. |
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| <span class="Apple-style-span" style="line-height: 13px; font-size: 13px">This 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"> Also with an increased hallux valgus or in cases of hallux limitus this mechanism didn’t function anymore.<ref name="Fuller">Fuller E.A., The Windlass Mechanism of the foot: A Mechanical model to explain pathology, Journal of the American Podiatric Medical Association, 2000, 35-46.</ref> </span>The test can be important in the decision-making process involved in the evaluation and treatment of [[Plantarfasciitis|plantar fasciitis]]</span> which is often seen in joggers, tennis players,... <ref name="Reid" /><!--StartFragment-->
| | [[Image:Windlass.jpg|center]] |
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-style: normal; font-size: 10pt; font-weight: normal; mso-bidi-font-weight: bold; mso-bidi-font-style: italic; mso-bidi-font-size: 11.0pt">A positive windlass test: heel pain reproduced with passive dorsiflexion of the toes.<ref name="maf" /></span></span>
| | The plantar aponeurosis originates from the base of the calcaneus and extends distally to the phalanges. Stretch tension from the plantar fascia prevents the spreading of the calcaneus and the metatarsals and maintains the medial longitudinal arch. The plantar fascia prevents foot collapse by virtue of its anatomical orientation and tensile strength. |
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| == Purpose of the test ==
| | 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 fascia shortening that results from hallux dorsiflexion is the essence of the windlass mechanism principle<ref name="Bolgla" />.<br> |
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">When we divided this test in some subclass of the [http://www.who.int/classifications/icf/en ICF], we can say that we measure the impairments of body structures: fascia and ligaments of the foot.</span></span> <ref name="DG">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.</ref>
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">It is a test to determine plantar fascia abnormalities is terms of over- and underpronation.<ref name="Lori" />(C) Such information is important clinically because it may provide healthcare professionals with a clear understanding bout the relationship between abnormalities and biomechanical influences.. <ref name="Lori">Lori A. Bolga and Terry R. Malone: Plantar fasciitis and the Windlass Mechanism: A biomechanical link to Clinical Practice, J. Athl. Train., 2004,77-82.</ref></span></span>
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">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)</span></span> <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">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.(A1)</span></span> <ref name="Hsin">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, 2008, 1937-1944.</ref> <br>
| | == Performing the Test == |
| <div style="mso-element: endnote-list"><div id="edn" style="mso-element: endnote"></div><div id="edn" style="mso-element: endnote">
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| == Clinically Relevant Anatomy ==
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| <!--StartFragment--><span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">To understand this test a good [[Anatomy|anatomic knowledge]] of the foot is indispensable. Therefore it’s important to know what happens in some movements, to get some good information you can read “Kapanji of the lower extremity”. </span></span> | | A positive windlass test: heel pain reproduced with passive dorsiflexion of the toes.<ref name="Amendola">Amendola A. Physical Examination of the Foot and Ankle. Musculoskeletal Physical Examination E-Book: An Evidence-Based Approach. 2016 Jul 27:199. </ref> |
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">One thing that’s important is that the ball of the foot is very important in shock absorbation.<ref name="maf" /><ref name="Reid" /> </span></span> | | The difference between bearing weight and non-weight is that the sensitivity is higher in weightbearing<ref name="Cole">Cole C. et al. ,Plantar fasciitis: evidence-based review of diagnosis and therapy, Am Fam Physican, 2005;73(11);2237-2242,2247-2248.</ref> De Garceau et al. showed 100% specificity for weight-bearing and sensitivity of 32 % for non-weight bearing tests.<ref name="mcp" /><ref name="dg" /> |
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">The windlass mechanism occurs during terminal stance when the heel is off the ground</span></span><span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">.<ref name="maf" /><ref name="Sarra">Sarrafian L.R, Functional characteristics of the foot and plantar aponeurosis under tibio-talar loading., Foot Ankle, 1987;8(1): 4-18</ref></span></span><span style="line-height: 13px" class="Apple-style-span"> <ref name="hicks">Hicks J.H., The mechanics of the foot. The plantar aponeurosis and the Arch, J Anat 1954;88: 25-30</ref>The windlass effecting acting trough the MTP joints with particular contribution from the first MTP joint.</span>
| | '''Non-weight bearing position:''' <ref name="mcp" /><ref name="dg">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.</ref><ref>Wong M., Pocket Orthopaedics: Evidence-Based Survival Guide(2010),Mississauga, Jones and Barlett Publishers, (p. 361).</ref> |
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">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.<ref name="maf" /> The plantar fascial bands envelops<span style="mso-spacerun: yes"> </span>the convex surface of the metatarsal heads producing the windlass effect.</span></span> <ref name="maf" />
| | Passively raise the toes of the patient while he/she is sitting to see whether this causes pain. |
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">It accumulates the tension in the plantar fascia, raises the longitudinal arc and tends to resist the posterior and superior rotation of the calcaneus.<ref name="Hunt">Hunt G.C. et al.: Biomechanical and histiological considerations for development of the plantar fasciitis and evaluation of arch taping as a treatment option the control associated plantar heel pain: a single-subject design, Foot AnkleElsevier Ltd., 2004, 147-53.</ref></span></span>
| | *The patient’s knee is flexed to 90° while in a non-bearing position |
| | *Examiner stabilized the ankle (with one hand placed just behind the first metatarsal head) and extends the MTP joint while allowing the IP to flex (preventing motion limitations due to short hallucis longus) |
| | *Positive test if pain was provoked at the end range of the MTP extension |
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| | '''Weight-bearing position '''<ref name="mcp">MC Poil T.G., Clincal Guidelines, Heel- Pain, Plantar Fasciitis, journal of orthopaedic and sports physical therapy, 2008, A1-A19.</ref><ref name="dg" /> |
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| | With the patient in a weight-bearing position, the examiner creates a great toe extension |
| <div style="mso-element: endnote-list">figure 1: Komentar P., The dicriptives stages of the gait cycle, (http://orthoteers.blogspot.com/2007/10/gait.html), internet, 15-05-2011.<br><div style="mso-element: endnote" id="edn">[[Image:Gait1.jpg|174x228px|Gait1.jpg]]</div></div><!--EndFragment-->
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| == Performance of the test ==
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">The difference between bearing weight and non-weight is that the sensibility is higher when the patient carries his weight.<ref name="Cole">Cole C. et al. ,Plantar fasciitis: evidence-based review of diagnosis and therapy, Am Fam Physican, 2005;73(11);2237-2242,2247-2248.</ref></span></span>
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| <span class="MsoIntenseReference"><u style="text-underline: thick"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">Non-weight bearing position: <ref>Wong M., Pocket Orthopaedics: Evidence-Based Survival Guide(2010),Mississauga, Jones and Barlett Publishers, (p. 361).</ref></span></u></span> <ref name="dg">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.</ref><ref name="mcp" /> (B)
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">Passively raise the toes of the patient while he/she is sitting to see whether this causes pain.</span></span>
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| *<span class="MsoIntenseReference"><span lang="EN-US"><span style="mso-list: ignore"> </span></span></span><span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">Patient’s knee is flexed to 90° while in non-bearing position</span></span>
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| *<span class="MsoIntenseReference"><span lang="EN-US"><span style="mso-list: ignore"> </span></span></span><span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">Examiner stabilized the ankle (with one hand placed just behind the first metatarsal head) and extends the MTP joint while allowing the IP to flex (preventing motion limitations due to short hallucis longus)</span></span>
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| *<span class="MsoIntenseReference"><span lang="EN-US"><span style="mso-list: ignore"> </span></span></span><span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">Positive test if pain was provocated at the end range of the MTP extension</span></span>
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| figure2: James G., Functional Hallux limitus, (http://www.lowerextremityreview.com/issues/october09/functional-hallux-limitus-diagnosis-and-treatment), internet, 2011.<br>[[Image:Gait.jpg]]
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| <span class="MsoIntenseReference"><u style="text-underline: thick"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">Weight-bearing position</span></u></span> <ref name="dg" /><ref name="mcp">MC Poil T.G., Clincal Guidelines, Heel- Pain, Plantar Fasciitis, journal of orthopaedic &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; sports physical therapy, 2008, A1-A19.</ref> (B)
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 11.0pt">With the patient in a weight bearing position, the examiner creates a great toe extension</span></span>
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| *The patient stands on a step stool and positions the metatarsal of heads of the foot to be tested just over the edge of the step. | | *The patient stands on a step stool and positions the metatarsal of heads of the foot to be tested just over the edge of the step. |
| *The subject is instructed to place equal weight on both feet. | | *The subject is instructed to place equal weight on both feet. |
| *The examiner then passively extends the first metatarsophalangeal joint while allowing the interphalangeal joint to flex. | | *The examiner then passively extends the first metatarsophalangeal joint while allowing the interphalangeal joint to flex. |
| *Passive extension (ie, dorsiflexion) of the first metatarsophalangeal joint is continued to its end of range or until the patient’s pain is reproduced. | | *Passive extension (i.e., dorsiflexion) of the first metatarsophalangeal joint is continued to its end of range or until the patient’s pain is reproduced. |
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| </v:shape><![endif]--><span lang="EN-US" style="line-height: 105%; font-size: 10pt; mso-bidi-font-size: 12.0pt; 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 evaluated with the Windlass test performed in a weightbearing and non-weightbearing position.<ref name="dg" /> 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</span><span lang="EN-US" style="line-height: 105%; mso-bidi-font-size: 12.0pt; 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>
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| A research of De Garceau et al. showed that the windlass test had a specificity of 100% and a sensitivity of 32 % fot the weight bearing and non-weight bearing tests. <ref name="mcp" /><ref name="dg" /> (B)
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| == Diagnostic ==
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| <span style="line-height: 13px; font-size: 13px" class="Apple-style-span">The plantar fascia strain increases with the increment of toe dorsiflexion angle and also with the increment of the Achilles tendon forces.</span> <ref name="Reid" />
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-style: normal; font-size: 10pt; font-weight: normal; mso-bidi-font-weight: bold; mso-bidi-font-style: italic; mso-bidi-font-size: 11.0pt"><span style="mso-spacerun: yes"> </span>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.</span></span> <ref name="Hsin">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.</ref>
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-style: normal; font-size: 10pt; font-weight: normal; mso-bidi-font-weight: bold; mso-bidi-font-style: italic; mso-bidi-font-size: 11.0pt">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). <ref name="Hsin">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</ref></span></span>
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-style: normal; font-size: 10pt; font-weight: normal; mso-bidi-font-weight: bold; mso-bidi-font-style: italic; mso-bidi-font-size: 11.0pt">After tests and X-ray the results showed that the maximum stress was concentrated near the medial calcaneal tubercle.</span></span><ref name="Finite element analysis of plantar fascia under stretch- the relative contribution of windlass mechanism and achilles tendon force.">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</ref>
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| <span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-style: normal; font-size: 10pt; font-weight: normal; mso-bidi-font-weight: bold; mso-bidi-font-style: italic; mso-bidi-font-size: 11.0pt">Backstorm and More<ref name="Back">Backstorm K.M., More A. Plantar fasciitis ; Phys Ther Case REp, 2000, 3: 154-162.</ref></span></span><span class="MsoIntenseReference"><span lang="EN-US" style="line-height: 105%; font-style: normal; font-size: 10pt; font-weight: normal; mso-bidi-font-weight: bold; mso-bidi-font-style: italic; mso-bidi-font-size: 11.0pt"> also suggested stretching using a contract-relax-contract [http://www.ipnfa.org PNF] method.</span></span>
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| == Key Research ==
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| <br>Brown C. A review of subcalcaneal heel pain and plantar fasciitis. Aust Fam Physician. 1996;25:875–885.
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| 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. <br>
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| == Clinical Bottom Line ==
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| A good knowledge of the anatomy and function of the foot are very important to understand this page.<br>
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| == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) ==
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| <div class="researchbox">
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| <rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1vm7YKsZZUUknheF8M5f39vRl9FXHsqNLytB1UNICHOUQdBk5l|charset=UTF-8|short|max=10</rss>
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| == Search Strategy ==
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| For search use: [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed], [http://www.archives-pmr.org/ Archives of Physical Medicine and Rehabilitation], [http://www.pedro.org.au/ PEDro]
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| Sugested keywords: Windlass-test, windlass-mechanism, toe dorsiflexion test, plantar fasciitis.
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| == References == | | == References == |
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| References will automatically be added here, see [[Adding References|adding references tutorial]].
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| <references /> | | <references /> |
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| [[Category:Vrije_Universiteit_Brussel_Project]][[Category:Articles]][[Category:Assessment]][[Category:EIM_Residency_Project]][[Category:Foot]][[Category:Musculoskeletal/Orthopaedics|Orthopaedics]][[Category:Special_Tests]][[Category:Videos]] | | [[Category:Foot]] |
| | [[Category:Musculoskeletal/Orthopaedics|Orthopaedics]] |
| | [[Category:Vrije_Universiteit_Brussel_Project]] |
| | [[Category:EIM_Residency_Project]] |
| | [[Category:Foot - Assessment and Examination]] |
| | [[Category:Primary Contact]] |
| | [[Category:Sports Medicine]] |
| | [[Category:Athlete Assessment]] |
| | [[Category:Special Tests]] |
| | [[Category:Foot - Special Tests]] |
