Tip Toe Standing Test: Difference between revisions

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== Purpose ==
== 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> 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 or other tone-influencing pathologies.
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" />  
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2. The patient is then asked to stand on tip toe.
2. The patient is then asked to stand on tip toe.


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



Revision as of 21:58, 17 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]

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 tip toe.

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]

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

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]