Biomechanical evaluation of two clinical tests for plantar heel pain: The dorsiflexion-eversion test for tarsal tunnel syndrome and the windlass test for plantar fasciitis

Alshami, A. M., Babri, A. S., Souvlis, T. and Coppieters, M.W. (2007) Biomechanical evaluation of two clinical tests for plantar heel pain: The dorsiflexion-eversion test for tarsal tunnel syndrome and the windlass test for plantar fasciitis. Foot & Ankle International, 28 4: 499-505. doi:10.3113/FAI.2007.0499


Author Alshami, A. M.
Babri, A. S.
Souvlis, T.
Coppieters, M.W.
Title Biomechanical evaluation of two clinical tests for plantar heel pain: The dorsiflexion-eversion test for tarsal tunnel syndrome and the windlass test for plantar fasciitis
Journal name Foot & Ankle International   Check publisher's open access policy
ISSN 1071-1007
Publication date 2007
Sub-type Article (original research)
DOI 10.3113/FAI.2007.0499
Volume 28
Issue 4
Start page 499
End page 505
Total pages 7
Place of publication Seattle, U.S.A.
Publisher Amer Orthopaedic Foot & Ankle Society
Collection year 2008
Language eng
Subject 320703 Peripheral Nervous System
321017 Orthopaedics
321024 Rehabilitation and Therapy - Occupational and Physical
C1
730303 Occupational, speech and physiotherapy
Abstract Background: Plantar heel pain may result from several conditions such as tarsal tunnel syndrome (TTS) and plantar fasciitis. The dorsiflexion-eversion test is used to diagnose TTS, whereas the windlass test is used for plantar fasciitis. Given the similarity between both tests, the purpose of this study was to evaluate whether these tests are able to selectively load the structures which they aim to examine. Methods: Both tests were evaluated in six cadavers by measuring strain in the plantar fascia, tibial nerve, lateral plantar nerve (LPN), and medial plantar nerve (MPN) using miniature displacement transducers. Longitudinal excursion of the nerves was measured with a digital caliper. Results: With the dorsiflexion-eversion test, dorsiflexion and eversion of the ankle in combination with extension of the metatarsophalangeal (NITP) joints significantly increased strain in the tibial nerve (+1.1%), LPN (+2.2%), and MPN (+3.3%) but also in the plantar fascia (+1.2%) (all: p = 0.016). Both components (dorsiflexion-eversion and MTP extension) resulted in significant increases. With the windlass test, extension of all MTP joints significantly increased strain in the plantar fascia (+0.4%, p = 0.016), but also in the tibial nerve (+0.4%, p = 0.016), LPN (+0.8%, p = 0.032) and MPN (+2.0%, p = 0.016). Excursion of the nerves was always in the distal direction but only reached significance for the tibial nerve (6.9 mm, p = 0.016) and LPN (2.2 mm, p = 0.032) during the dorsiflexion-eversion test. Conclusions: Both tests mechanically challenge various structures that have been associated with plantar heel pain. This questions the usefulness of the tests in the differential diagnosis of plantar heel pain.
Keyword Orthopedics
biomechanics
clinical test
diagnosis
heel pain
plantar fasciitis
tarsal tunnel syndrome
Tibial Nerve Tension
1st Branch
Strain
Excursion
Diagnosis
Foot
Entrapment
Position
Release
Motion
Q-Index Code C1
Q-Index Status Confirmed Code

 
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Created: Mon, 18 Feb 2008, 16:52:47 EST