Silfverskiold Test

What is the Silfverskiold Test?

Before we talk about the , let’s discuss what an equinus deformity is.

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An equinus deformity is a kind of condition in the ankle that limits its dorsiflexion. If a person has this deformity, it has likely affected their gait in such a way that they have difficulty walking, running, climbing stairs, and even putting on pants because they have to lift their leg higher than they usually do to wear them.

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If left unchecked for too long, the equinus deformity can result in various ankle and foot-related problems, like cramps in the calf, bunions, hammer toes, ankle pain, plantar fasciitis, and tendonitis. More often than not, people who have equinus deformity are unaware of its presence!

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Such a deformity is normally caused by the tightness of soleus muscles, gastrocnemius muscles, and/or the Achilles tendon. This is where the Silfverskiold Test comes into play.

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The Silfverskiold Test is a physical examination technique developed to help healthcare professionals assess the cause of foot or ankle pain. It tries to determine if the cause of ankle pain is due to the tightness of the soleus or gastrocnemius muscles through ankle dorsiflexion and knee flexion.

How to perform the Silfverskiold Test

Before you perform the Silfverskiold Test, you must know that this test does not require anything special from the healthcare professional. It’s a non-invasive test, so it doesn’t require complicated tools. The only things that a professional needs are their own two hands, a goniometer, and a comfortable examination bed for their patient.

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Once you have prepared the examination bed, do the following:

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• Have your patient lie down in a supine position (they have to be facing up) or you can have them sit up straight on the bed. Go with what’s comfortable for your patient.
• Next, position yourself on the patient's side where they feel ankle or foot pain. If they feel pain on both sides, you’ll have to do this test twice to account for both feet.
• Once you’re in position, extend the patient’s knee. While the knee is extended, dorsiflex the ankle. Make sure to measure the dorsiflexion. You can use the goniometer for that.
• Next, gradually bend the knee until it is in 90-degree flexion. While it is in flexion, dorsiflex the ankle and measure it.
• Note down the differences in range of ankle dorsiflexion while the knee is extended and while it is in flexion.

How to interpret the findings of the Silfverskiold Test

Once you have performed the Silfverskiold Test and you’ve noted down the differences in ankle dorsiflexion for both scenarios, here are the things that you need to take note of:

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• If there is a significant difference in ankle dorsiflexion for both scenarios (knee being extended and knee being flexed 90 degrees), designate the patient as positive.
• If there is no significant difference, designate them as negative.
• If they are positive, you have to designate specifically if the soleus or gastrocnemius muscle is the one causing the potential ankle or foot problem.
• If the ankle dorsiflexion is greater with the knee extended than when the knee is flexed, that is a sign of gastrocnemius muscle contracture. This means that this muscle is tighter than the soleus muscle. If there is gastrocnemius muscle contracture, it might point to the patient having a possible ankle sprain, ankle stress fractures, or even shin splints, just to name a few conditions.
• If the ankle dorsiflexion is greater with the knee flexed than the knee extended, that is a sign of soleus muscle contracture. This means that this muscle is tighter than the gastrocnemius muscle. If there is soleus muscle contracture, it might point to the patient having plantar fasciitis, Achilles tendinopathy, or even metatarsalgia.
• If they test positive, it’s best to endorse them for a comprehensive examination to confirm whatever specific ankle problem they have. If they test negative for this but are still complaining about ankle pains, then another test might be able to determine the possible problem.

When is it best to conduct the Silfverskiold Test?

The best time to conduct the Silfverskiold Test is when a patient attends their appointment with you and talks about aches in their ankle or foot, especially if the pain is in the posterior section of the ankle, the Achilles tendon, or the heel.

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It is often used when healthcare professionals want to gauge lower extremity problems in patients and see if they possibly have conditions like the ones we mentioned earlier in the section about interpreting the test findings.

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In that same section, we mentioned that whichever result you get (especially if they are still feeling pain even if they got a negative designation), the next step should be to endorse them for a comprehensive examination, which will involve other tests. This is because the Silfverskiold Test is a physical examination technique, so it can only give you surface-level results.

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That’s not to say that the results are unreliable. It is reliable because if there is pain and a notable difference in dorsiflexion in the ankle when the knee is extended and flexed, then that’s a sign that either the soleus or gastrocnemius muscle is tight. Both muscle contractures point to possible problems, and the comprehensive examination is to determine the specific problem while using the Silfverskiold Test result as grounding.

Who can conduct the Silfverskiold Test, and who is it for?

Since the Silfverskiold is a physical examination technique meant to assess the source of ankle pain in patients, the best healthcare professionals who can perform/conduct this test are those who have been highly trained to analyze and treat patients who are dealing with musculoskeletal concerns and conditions, especially when it comes to the lower extremities.

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These healthcare professionals are usually orthopedists, podiatrists, physiologists, physical therapists, occupational therapists, chiropractors, rehabilitation specialists, and sports doctors.

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Podiatrists specialize in dealing with conditions related to the feet and ankles. They, as well as orthopedists, can use this as part of their comprehensive examinations to properly assess a person’s ankle ailments, diagnose them, and treat them accordingly.

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Physical therapists and other adjacent professionals can perform this technique to evaluate the ankles and feet. They can provide the necessary rehabilitation plans to help restore the ankle to a better state.

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It’s always best to leave this technique to be performed by such professionals because this involves manually examining the ankle of the patient using their hands. These professionals know how to perform the technique well enough to get the necessary results and gentle enough not to cause unnecessary pain and discomfort. If someone who is not well-trained performs this technique, they risk aggravating whatever potential ankle or foot problems the patient has, which all professionals want to avoid.

What are the Benefits of the Silfverskiold Test?

It is an easy test to perform.

The Silfverskiold Test is one of the easiest physical examination techniques to perform. The instructions are simple and not at all difficult to do, so any healthcare professional performing this will be able to finish in a minute or three. It also doesn’t require much from the professional since it only requires an examination bed and a goniometer to measure the angle of the ankle while dorsiflexed.

It’s a non-invasive but accurate test.

While we did mention earlier that the Silfverskiold Test gives surface-level results, that doesn’t mean those results are unreliable. Since you will be measuring the difference in ankle dorsiflexion using the goniometer when the knee is straightened and when the knee is in flexion, you have an objective assessment of the ankle. It is accurate because it can determine if the gastrocnemius muscle or the soleus muscle is the source of tightening in the ankle, and the specific muscle will point to certain conditions. The results of the test will help other members of your team determine what to do by using the results as grounding.

It can help determine what goes into a treatment plan.

Just as it can help determine how to go about examining the patient, the Silfverskiold Test, by extension, can also help professionals determine what goes into a treatment plan down the line, especially when further testing confirms that a certain muscle contraction is occurring in the ankle and if the ankle has a condition tied to that muscle contraction. The treatment should then be geared toward treating either the gastrocnemius or the soleus muscle and the conditions resulting from its contraction.

It can help with monitoring the patient down the line.

So, let’s stipulate that your team has developed and implemented a treatment plan for the patient, and the patient has been following it. Naturally, you’d like to know if they are getting better, so routine check-ups are included in this plan. You can repeat this test during a routine check-up to check your patient’s progress. If you notice that the difference between the dorsiflexion is getting smaller and close to normal, then the treatment plan is working and the patient is slowly getting better. If it’s still the same or is getting worse (especially the pain), you might want to make adjustments or overhaul the plan to see if the changes do the trick.