Ankle Orthopaedic Test: Windlass Test

The Windlass Test is a physical examination technique used to assess the integrity of the plantar fascia ligament in the foot. 

Here is the step-by-step procedure to perform the test:

1. The patient should be positioned in a seated or lying down position with the affected leg extended.
2. The examiner should stabilize the patient's foot by holding the heel with one hand while using the other hand to apply pressure on the base of the toes.
3. The examiner should then passively dorsiflex the patient's foot while maintaining the pressure on the base of the toes.
4. The examiner should continue to dorsiflex the patient's foot until the patient reports pain or resistance is felt.
5. At this point, the examiner should slowly lower the foot back to its starting position.
6. The examiner should then repeat the procedure, this time asking the patient to actively dorsiflex the foot while the examiner applies pressure on the base of the toes.
7. If pain or resistance is felt during either passive or active dorsiflexion, this is considered a positive Windlass Test, which suggests the presence of plantar fasciitis or other conditions that affect the plantar fascia.

A positive test result indicates the presence of plantar fasciitis, while a negative result suggests the absence of the condition. However, it's important to note that the sensitivity and specificity of the Windlass Test are not well-established.

References:

1. Martin RL, Irrgang JJ, Conti SF. Outcome study of subjects with insertional plantar fasciitis. Foot Ankle Int. 1998;19(12):803-811. doi:10.1177/107110079801901203
2. Redmond AC, Crosbie J, Ouvrier RA. Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index. Clin Biomech (Bristol, Avon). 2006;21(1):89-98. doi:10.1016/j.clinbiomech.2005.08.002
3. Wearing SC, Smeathers JE, Urry SR, Hennig EM, Hills AP. The pathomechanics of plantar fasciitis. Sports Med. 2006;36(7):585-611. doi:10.2165/00007256-200636070-00004
4. Beeson P. Plantar Fasciitis. UpToDate. Accessed March 25, 2022. https://www.uptodate.com/contents/plantar-fasciitis
5. DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am. 2003;85(7):1270-1277. doi:10.2106/00004623-200307000-00012
6. Williams R, Brody D. The Windlass Mechanism: An Essential Component of Gait? Foot Ankle. 1987;8(6):279-283. doi:10.1177/107110078700800604
7. Zammit GV, Menz HB, Munteanu SE. Plantar fasciitis and the Windlass mechanism: a biomechanical link to clinical practice. J Foot Ankle Res. 2010;3:5. doi:10.1186/1757-1146-3-5