Silfverskiold Test
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Purpose
The Silfverskiöld test is used to identify isolated gastrocnemius contracture associated with several foot and ankle pathologies. The test was first described by Nils Silfverskiöld [1]. The Silfverskiöld test differentiates gastrocnemius tightness from an achilles tendon contracture by evaluating ankle dorsiflexion with the knee extended and then flexed[2].
Technique
It measures the dorsiflexion (DF) of the the ankle joint with knee extended & flexed to 90 degrees. The test is considered positive when DF at the ankle joint is greater with the knee flexed than extended.
The test is performed with the patient seated or in supine. Two hands are utilized to perform the technique, with one hand neutralizing and locking the subtalar (ST) joint and the other stabilizing the talonavicular (TN) joint and forefoot in order to isolate the ankle joint motion[3]. With the subtalar joint (STJ) in neutral, forefoot is supinated and foot is dorsiflexed with knee in full extension. Measurement is taken of the DF range. Then the test is repeated with knee flexed at 90 degrees.
Less dorsiflexion with a soft and spongy feel when the knee is extended, indicates a gastroc contracture and equally limited DF with the knee flexed and extended, points to either a soleal equinus or an osseous block.
Evidence
One study compares the validity of the Silfverskiöld test to a device that measures ankle range of motion[5]. Inter- and intrarater reliability testing of the clinical Silfverskiöld test was found to have ICC values of 0.230 to 0.791. poor inter- and intrarater reliability where the devices was over 0.85 for both inter- and intrarater reliability.
A study by Picelli et al[6], looked at how useful the Silfverskiöld test is with diffentiating overactivity of the gastrocnemius versus soles in patient with a spastic equinus foot. Each subject had the Silfverskiöld test performed and it was determined to be a positive if the passive dorsiflexion was greater with the knee flex versus extended. Then a diagnostic nerve block of the tibial motor nerve branches was performed of the soleus, gastrocnemius and tibialis posterior muscles in that order then reassessed. It was found there was no association between the Silfverskiöld test and spastic overactivity of any of these muscles.
References
- ↑ SilfverskiöldN.: Reduction of the uncrossed two-joints muscles of the leg to one-joint muscles in spastic conditions. Acta Chir Scand;1924
- ↑ DiGiovanni CW, Kuo R, Tejwani N, et al: Isolated gastrocnemius tightness. J Bone Joint Surg Am 2002
- ↑ Hansen ST. Functional reconstruction of the foot and ankle. Lippincott Williams & Wilkins; 2000.
- ↑ Assessing foot Flexibility
- ↑ Molund, M., Husebye, E. E., Nilsen, F., Hellesnes, J., Berdal, G., & Hvaal, K. H. (2018). Validation of a new device for measuring isolated gastrocnemius contracture and evaluation of the reliability of the Silfverskiöld test. Foot & ankle international, 39(8), 960-965.
- ↑ Picelli, A., DI CENSO, R., Angeli, C., Spina, S., Santamato, A., Baricich, A., ... & Filippetti, M. (2024). Is the Silfverskiöld Test a valid tool for evaluating calf muscles spastic overactivity in patients with stroke? A retrospective observational study. European Journal of Physical and Rehabilitation Medicine, 60(5), 761.