Tip Toe Standing Test

Original Editor - Lauren Heydenrych

Top Contributors - Lauren Heydenrych

Purpose

The purpose of a tip toe standing test is to differentiate between the two different categories of flatfoot (pes planus), namely flexible flatfoot and fixed flatfoot. It is important to differentiate flexible from fixed as the prognosis and intervention of the two presentations are vastly different. In addition, the presentation of a fixed flatfoot deformity flags possible underlying pathologies which could include cerebral palsy, other tone-influencing pathologies or tarsal coalition.

This is an indirect, observational method of assessment.

To further test for a flexible flatfoot, the Hubscher maneuver (or Jack's test) can also be done.

Technique

1. The patient stands on flat ground. This can be done at a wall or other place where external support can be used.

2. The patient is then asked to stand on tiptoe.

Result and Interpretation

In a flexible flatfoot the heel will turn inwards (varus position) and the medial arch will become apparent.

In fixed flatfoot, the medial longitudinal arch will remain unobservable.

Figure A: Medial Arch collapse in weight bearing. During weight-bearing, the disappearance of the medial longitudinal arch of the foot is seen. On posterior view, angling of the Achilles tendon (hindfoot valgus) is observed.

	Figure B: Tiptoe test. While raising up on tiptoe, reconstruction of the medial longitudinal arch collapsed during weight-bearing is observed.