Tip Toe Standing Test: Difference between revisions

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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.
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.


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


== Result and Interpretation ==
== Result and Interpretation ==
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{{#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>
{{#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>


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



Revision as of 19:55, 29 August 2022

Original Editor - User: 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]