Windlass Test

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Search Strategy

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Definition/Description

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

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. [ii]<o:p></o:p>

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<o:p></o:p>

A positive windlass test: heel pain reproduced with passive dorsiflexion of the toes.<o:p></o:p>

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[i] Viel, E ; Esnault M. The effect of increased tension in the plantar fascia : a biomechanical analysis Physiother Practica 1989 ;5 :69-73

[ii] Lori A. Bolga; Terry R. Malone: Plantar fasciitis and the Windlass Mechanism: A biomechanical link to Clinical Practice

Purpose of the test

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

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Performance of the test

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

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

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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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