Lecture Notes: Special Testing in Clinical Evaluation

Introduction to Special Testing

• Special testing is a crucial part of clinical evaluations.
• Prior Steps:
  • Collect patient history.
  • Conduct inspection.
  • Perform palpation.

Understanding Foot Posturing

Feiss Line Test

• Purpose: Determine the foot posture type.
• Tools Needed:
  • Two pins of different colors.
  • Ruler.
• Procedure:
  • Mark the tip of the medial malleolus and the most inner portion of the metatarsal phalangeal joint of the first ray.
  • Draw a line between these points.
  • Patient stands up; observe where the navicular falls relative to this line.
• Interpretation:
  • Above line: Pes cavis (high arch).
  • Within line: Normal foot posture.
  • Below line: Pes planus (flat foot).

Navicular Drop Test

• Purpose: Assess navicular movement.
• Tools Needed:
  • Pin, note card, measuring tape.
• Procedure:
  • Mark navicular in seated position and measure distance to the floor.
  • Patient stands; measure distance again.
• Interpretation:
  • No change: Pes cavis.
  • Significant drop (>10mm): Pes planus.

Windlass Effect Test

• Purpose: Evaluate arch behavior.
• Procedure Stages:
  1. Seated Position: Check for presence of arch.
     • No arch: Congenital abnormality (stop test).
  2. Standing Position: Observe if arch disappears.
  3. Toe Position: Check if arch reappears when patient stands on tiptoes.
• Interpretation:
  • Arch disappears and reappears: Pes planus.

Tests for Fractures

Long Bone Compression Test

• Purpose: Detect fractures in metatarsals or phalanges.
• Procedure:
  • Compress the phalange against the metatarsal.
• Interpretation: Positive test indicated by pain.

Torque Test

• Purpose: Identify fracture sites.
• Procedure:
  • Apply pressure above and below the fracture site to bend the bone.
• Interpretation: Pain at the fracture site indicates a positive test.

Tap Test

• Purpose: Check for phalangeal fractures.
• Procedure:
  • Tap the distal end of the phalange and watch for pain indication.

Tests for Neural or Interdigital Neuroma Issues

Interdigital Neuroma Test

• Purpose: Elicit pain due to nerve impingement.
• Procedure:
  • Squeeze first and fifth metatarsals together.
• Interpretation: Positive if numbness/tingling occurs.

Thumb Index Finger Test

• Purpose: Detect neural pain between metatarsals.
• Procedure:
  • Compress between suspected metatarsal heads using thumb and index finger.
• Interpretation: Positive with numbness or tingling.

Tinel's Test

• Purpose: Identify issues with the posterior tibial nerve.
• Procedure:
  • Tap the posterior tibial nerve area.
• Interpretation: Positive if numbness or tingling is reported.

Conclusion

• Special tests provide essential insights into foot postures, fractures, and neural issues.
• Accuracy and proper technique are essential to mitigate clinician error.