Tip Toe Standing Test: Difference between revisions

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'''Original Editor '''- [[User:Lauren Heydenrych|Lauren Heydenrych]]
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== Purpose ==


<div class="editorbox"> '''Original Editor '''- [[User:User Name|User Name]]<br>
The purpose of a tip toe standing test is to differentiate between the two different categories of flatfoot ([[Pes Planus|pes planus]]), namely flexible flatfoot and fixed flatfoot.<ref name=":0">Rodriguez N, Volpe RG. [https://www.sciencedirect.com/science/article/abs/pii/S0891842209000731?via%3Dihub Clinical diagnosis and assessment of the pediatric pes planovalgus deformity]. Clinics in Podiatric Medicine and Surgery. 2010 Jan 1;27(1):43-58.</ref> 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.
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
== Purpose ==


The purpose of  a tip toe standing test is to differentiate between the two different categories of flatfoot ([[Pes Planus|pes planus]]), namely flexible flatfoot and fixed flatfoot.<ref name=":0">Rodriguez N, Volpe RG. [https://www.sciencedirect.com/science/article/abs/pii/S0891842209000731?via%3Dihub Clinical diagnosis and assessment of the pediatric pes planovalgus deformity]. Clinics in Podiatric Medicine and Surgery. 2010 Jan 1;27(1):43-58.</ref>
This is an indirect, observational method of assessment.<ref name=":0" />


This is an indirect, observational method of assessment.<ref name=":0" />
To further test for a flexible flatfoot, the Hubscher maneuver (or [[Jack Test|Jack's test]]) can also be done.  


== Technique ==
== Technique ==
1. The patient stands on flat ground. This can be done at a wall or other place where external support can be used.
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 tip toe. In a flexible flatfoot the heel will turn inwards (varus position) and the medial arch will become apparent. In a fixed flatfoot the medial longitudinal arch will remain unobservable.<ref>Alazzawi S, Sukeik M, King D, Vemulapalli K. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241541/ Foot and ankle history and clinical examination: A guide to everyday practice]. World Journal of Orthopedics. 2017 Jan 18;8(1):21.</ref>
2. The patient is then asked to stand on tiptoe.
 
To further test for a flexible flatfoot,  the Hubscher maneuver (or Jack's test) can also be done.  [[File:Medial arch collapse.png|thumb|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.]][[File:Tiptoe test.png|thumb|Figure B: Tiptoe test. While raising up on tiptoe, reconstruction of the medial longitudinal arch collapsed during weight-bearing is observed.]]
 
 


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


{{#ev:youtube|nolevVWzdio|300}}<ref>Dr. Estefania Birrer Gonzalez. Toe Standing Test For Flexible Flatfoot. Available from: https://www.youtube.com/watch?v=nolevVWzdio [last accessed 16/07/2022]</ref>
In '''fixed flatfoot,''' the medial longitudinal arch will remain unobservable.<ref>Alazzawi S, Sukeik M, King D, Vemulapalli K. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241541/ Foot and ankle history and clinical examination: A guide to everyday practice]. World Journal of Orthopedics. 2017 Jan 18;8(1):21.</ref>[[File:Medial arch collapse.png|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.|alt=|left|thumb]]
{|
|+
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![[File:Tiptoe test.png|thumb|Figure B: Tiptoe test. While raising up on tiptoe, reconstruction of the medial longitudinal arch collapsed during weight-bearing is observed.|alt=|center]]
|}


==== Performance of Tip Toe Standing Test ====
{{#ev:youtube|nolevVWzdio|500}}<ref>Dr. Estefania Birrer Gonzalez. Toe Standing Test For Flexible Flatfoot. Available from: https://www.youtube.com/watch?v=nolevVWzdio [last accessed 16/07/2022]</ref>


== References  ==
== References  ==


<references />
<references />
[[Category:Foot]]
[[Category:Foot - Assessment and Examination]]
[[Category:Paediatrics - Assessment and Examination]]

Latest revision as of 19:07, 3 September 2022

Original Editor - Lauren Heydenrych

Top Contributors - Lauren Heydenrych

Purpose[edit | edit source]

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.[1] 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.[1]

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

Technique[edit | edit source]

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[edit | edit source]

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.[2]

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.

Performance of Tip Toe Standing Test[edit | edit source]

[3]

References[edit | edit source]

  1. 1.0 1.1 Rodriguez N, Volpe RG. Clinical diagnosis and assessment of the pediatric pes planovalgus deformity. Clinics in Podiatric Medicine and Surgery. 2010 Jan 1;27(1):43-58.
  2. Alazzawi S, Sukeik M, King D, Vemulapalli K. Foot and ankle history and clinical examination: A guide to everyday practice. World Journal of Orthopedics. 2017 Jan 18;8(1):21.
  3. Dr. Estefania Birrer Gonzalez. Toe Standing Test For Flexible Flatfoot. Available from: https://www.youtube.com/watch?v=nolevVWzdio [last accessed 16/07/2022]