Windlass Test

What is the Windlass Test?

The Windlass Test, developed by John Hicks (1954), is a physical examination technique that assesses the functionality and integrity of the plantar fascia to help diagnose plantar fasciitis. It evaluates the windlass mechanism principle of the foot—a concept derived from a winch or “windlass” mechanism, where the plantar fascia acts like a cable, pulling to support the foot’s arch when the toes are dorsiflexed. This action shortens the plantar fascia and stabilizes the medial longitudinal arch. As such, the plantar fascia prevents foot collapse during gait.

The plantar fascia—also known as the plantar aponeurosis—is a thick connective tissue. The plantar aponeurosis originates from the calcaneus and extends to the toes. The plantar fascia supports the arch while vertical forces body weight travel downward during gait and weight-bearing activities, distributing these forces and letting the arch absorb shock. Plantar fascia shortening stabilizes foot position, contributing to balance and movement efficiency. When a person stands or walks, the plantar fascia simulates a cable pulling up on the arch, creating a stable foundation for the foot.

In patients with plantar fasciitis, a degenerative condition affecting the plantar fascia, the windlass mechanism is often compromised. Plantar fasciitis typically causes heel pain, worsened by weight-bearing activities, and may relate to an insufficient “dynamic truss” of the medial longitudinal arch and weakness in intrinsic foot muscles (Soysa et al., 2012). The test is highly specific, with De Garceau et al. (2003) reporting a 100% specificity in weight-bearing assessments but only a 31.8% sensitivity in non-weight-bearing tests, indicating it’s more reliable for ruling in the diagnosis than for ruling it out.

Symptoms of plantar fasciitis include:

• Heel and arch pain, often felt in the morning or after long periods of inactivity.
• Tenderness and stiffness, particularly at the bottom of the heel.
• Swelling or warmth, especially after prolonged activity.

Podiatrists, physical therapists, orthopedists, and sports physicians are all qualified to conduct the Windlass Test due to their expertise in diagnosing and treating musculoskeletal and foot-related conditions. These professionals possess the knowledge to interpret test results accurately and integrate them into a comprehensive treatment plan when managing conditions like plantar fasciitis.

How to use our Windlass Test template

Our Windlass Test template provides a structured guide for documenting and conducting both non-weight-bearing and weight-bearing variations of the test. It includes sections for patient information, step-by-step procedures, and areas to note observations and results. Here’s how to use it:

Step 1: Access the template

To begin, access our template by clicking the “Use template” button to open it in our app for easy customization, or select the “Download” button to save and print a copy.

Step 2: Administer the test

Have the patient lie supine on an examination table for the non-weight-bearing test. Stabilize their ankle in a neutral position and gently extend their first metatarsophalangeal joint, observing the arch’s response. For the weight-bearing test, ask the patient to stand on a stool with the metatarsal heads just beyond the stool’s edge and apply the same toe extension. These procedures assess the plantar fascia’s ability to support the arch effectively.

Step 3: Record and interpret test results

Document the observed results in the designated fields. A negative test shows increased plantar fascia tension and a pronounced arch upon toe extension. A positive test indicates pain in the metatarsal, arch, or heel or insufficient tension in the plantar fascia to lift the arch. This insight aids in identifying plantar fasciitis and monitoring progress.

Step 4: Discuss the findings with the patient

Use the template as a reference when explaining the test results to the patient. Discuss the implications of a positive or negative result and potential next steps. You may also provide the patient with a printed copy of the filled template to take home.

How to interpret the Windlass Test's results

The Windlass Test results indicate the plantar fascia's tension and functionality, helping diagnose plantar fasciitis. Here’s what each outcome means:

• Negative test: The test is negative if the plantar fascia produces enough tension to elevate the medial longitudinal arch during toe extension and no pain occurs. This suggests that the plantar fascia functions normally and that plantar fasciitis is unlikely. Observing the arch lift as the plantar fascia shortens indicates structural integrity, allowing the body weight to travel downward smoothly during gait.
• Positive test: A positive Windlass Test is when the patient feels pain in the metatarsal, arch, or heel or when the plantar fascia simulates a cable but does not generate sufficient tension to lift the arch.

The relationship between plantar fasciitis and Windlass Test results is especially strong with a positive weightbearing test, as it suggests compromised plantar fascia support and may warrant further evaluation.

When is it best to conduct the Windlass Test?

The Windlass Test is most effective for patients presenting with heel pain or discomfort along the medial longitudinal arch—common symptoms of plantar fasciitis. It’s also recommended when patients report increased pain during standing, walking, or after periods of rest, especially first thing in the morning.

• Initial evaluation: Conduct the test during the first appointment if the patient’s symptoms align with plantar fasciitis indicators.
• Follow-up assessment: Patients undergoing treatment should periodically use the test to monitor improvement or evaluate the need for adjustments in their care plan.
• Patients with a history of foot pain: If patients have documented or recurring foot pain, including heel and arch pain, the Windlass Test can provide a quick check on plantar fascia integrity, ensuring prompt management if symptoms reoccur.

What are the benefits of the Windlass Test?

The Windlass Test offers several advantages for both healthcare providers and patients:

• Quick and cost-effective: This test requires no specialized equipment, just basic items like an examination table or stool, making it accessible and efficient for clinical use.
• Supports diagnostic accuracy: A positive weight-bearing Windlass Test is highly specific for diagnosing plantar fasciitis, helping to confirm or rule out this condition.
• Guides treatment plans: The test results can help healthcare providers tailor treatment strategies, whether for initial interventions or ongoing monitoring of progress.
• Monitors patient recovery: For patients in rehabilitation, the Windlass Test can track improvements, providing insights into treatment effectiveness and recovery over time.

References

De Garceau, D., Dean, D., Requejo, S. M., & Thordarson, D. B. (2003). The association between diagnosis of plantar fasciitis and Windlass Test results. Foot & Ankle International (Foot Ankle Int), 24(3), 251–255. https://doi.org/10.1177/107110070302400309

Hicks, J. H. (1954). The mechanics of the foot: II. The plantar aponeurosis and the arch. Journal of Anatomy (J Anat), 88(Pt 1), 25. https://pmc.ncbi.nlm.nih.gov/articles/PMC1244640/

Soysa, A., Hiller, C., Refshauge, K., & Burns, J. (2012). Importance and challenges of measuring intrinsic foot muscle strength. Journal of Foot and Ankle Research (J Foot Ankle Res), 5(1). https://doi.org/10.1186/1757-1146-5-29