Windlass Test

What is the Windlass Test?

Before we discuss what the is, let’s first talk about Plantar Fasciitis.

The Plantar Fascia is an important part of the foot because it supports the arch and serves as a shock absorber. It actually bears our full weight whenever we are standing, walking, or running. Based on this, it’s not incorrect to assume that this part of our foot is strong, however, it has its limits.

If you’re on your feet all day, whether it’s for work, sports, or something recreational like exercising, your Plantar Fascia might get irritated or damaged! If you walk or stand without wearing footwear, or if you are wearing footwear that isn’t comfortable or supportive, your Plantar Fascia might also get irritated or damaged.

If the Plantar Fascia is irritated or damaged enough, a person may suffer a condition known as Plantar Fasciitis, one of the most common causes of foot and heel pain. When Plantar Fasciitis is present, a person might feel:

• A prickling or stabbing sensation in the arch of the foot
• The feeling of something biting on your heel, especially when you take a step
• There is stiffness in the foot
• There is swelling in the heel

In order to gauge a person if they are suffering from Plantar Fasciitis, healthcare professionals often administer the Windlass Test, a physical examination technique where the professional flexes a person’s foot to observe if the arch of the foot rises or not.

Have a look at this video to see how the assessment is performed:

How to conduct the Windlass Test

The Windlass Test is an easy-to-perform test that does not require any special equipment in order to be performed. It’s also quick to administer, so it shouldn’t take five minutes to be accomplished and assessed.

There are two things that you need in order to perform this physical examination technique. The first one is a flat surface that your patient can lie down or sit on, preferably an examination table or bed. Make sure this is elevated. The second thing you need for this particular test is a stool because this test is also performed while a patient is standing.

Once you have these prepared in the space where you will be conducting the Windlass Test, here are the instructions that you need to follow:

• Tell the patient to lie down in a supine position (face up) on the examination table or bed. Make sure that their legs are straight.
• Next, tell the patient to dorsiflex their affected foot. Dorsiflex, in this context, means they have to point their affected foot upward.
• While the patient is dorsiflexing their affected foot, you will use one of your hands to grasp the foot’s big toe.
• Pull back the big toe towards the ankle to apply tension to the foot’s Plantar Fascia.
• While you are pulling their big toe towards their ankle, use your other hand to palpate the medial arch of the affected foot. Your objective with this hand is to feel for any changes in the shape of the arch.
• Once you’ve felt what you needed to feel from the arch, let go of the foot and tell your patient to relax their foot and un-dorsiflex it.
• Repeat these steps with the other foot.
• After repeating these steps with the other foot, conduct this test again while the person is seated on the examination table/bed.
• Repeat this test again, this time while the patient is standing on a stool. While standing up, make sure that their first metatarsal is on the edge of the stool so that you have room to pull up their big toe.

How to interpret the Windlass Test’s results

In order to know if the person is positive for Plantar Fasciitis, you need to observe and feel any changes in the person’s Plantar Fascia, specifically during the step where you palpate the affected foot’s medial arch.

The test is negative if there is an increase in tension in the Plantar Fascia, and you can observe that the arch of the foot rises as you pull back the big toe. The arch should become more pronounced. This means the Plantar Fascia is generating enough tension to support the arch. This is good!

The test is positive if there is no increase in tension or there is not enough tension in the Plantar Fascia to lift the arch of the foot, meaning the arch is just flat or collapsed. If the patient also feels pain in the metatarsal, arch, or heel as you conduct this test, the results are positive. This is not good!

If the results are positive, the next step is to endorse them for further examination to check for other issues and to confirm the diagnosis.

When is it best to conduct the Windlass Test?

If you have a patient that sets up an appointment with you because they said they feel pain in their feet, especially their heels or medial arches, then the moment they arrive for their appointment is the best time to conduct the Windlass Test. Obviously, you and the patient would want the pain to be addressed as soon as possible, so conducting this test will give practitioners the opportunity to determine how to treat their pain as early as possible.

Though, do recall what we mentioned earlier about the next step you must take after conducting this test, which is to endorse them for further examination. The reason for this is that even if a patient tests positive, that does not necessarily mean that Plantar Fasciitis is the specific condition that they have. They might have Hallux Rigidus or some other ailment. Including this as part of a more comprehensive examination is the best choice to get to the bottom of things because other tests, including imaging tests, can confirm the suspicions based on the Windlass Test results. When the suspicions are confirmed, an official diagnosis can be made, and treatment plans can be developed accordingly!

Also, another way to know if conducting the Windlass Test is appropriate is by checking the patient’s medical history. If they are complaining about pains in the entirety of their lower extremities, then the Windlass Test might be an appropriate test to conduct, especially if their medical records show that they have felt heel or foot pain before.

Who can conduct the Windlass Test?

Since the Windlass Test is a physical examination technique that is performed on a person’s foot, the best healthcare professionals that can conduct this test are podiatrists! The reason for this is that podiatrists specialize in assessing and treating people for problems in their legs and feet!

They can conduct physical examinations on patients to determine what their conditions are, they can prescribe medication for their conditions, order lab tests, and even conduct surgeries if necessary! Given that they are highly trained and experienced in this particular branch of medicine, they are well-equipped and capable of performing physical examination techniques such as the Windlass Test, and they know if it’s necessary to include the Windlass Test as part of a comprehensive examination.

Of course, this doesn’t mean that conducting the Windlass Test is exclusive to them. Physical therapists and orthopedists can conduct them since they are also knowledgeable about musculoskeletal conditions and how to assess and treat them. Sports physicians are also allowed to conduct this because they work with athletes, and heel pain is common among athletes.

So long as the professional is highly trained and experienced in dealing with and treating conditions related to the foot, they can definitely conduct this test as part of their comprehensive examinations.

What are the benefits of the Windlass Test?

It’s an inexpensive and easy test to conduct!

The Windlass Test is technically a physical examination technique that doesn’t require professionals to have special equipment. The only things that a professional needs are an examination table or a comfortable examination bed, a stool, and their own two hands!

The Windlass Test instructions are also straightforward and easy to follow, so the test can be accomplished in just a few minutes, and you can get immediate results.

It is a type of technique that can help diagnose patients and guide treatment.

The Windlass Test will test positive for possible Plantar Fasciitis or perhaps another condition if the professional notices certain things while conducting the test, like the Plantar Fascia not rising to form a pronounced arch and if the patient feels pain during the test. While these are signs pointing to a condition, it does not necessarily confirm it. Once other tests have been conducted, the results from the Windlass Test can be used alongside the results of other tests in order to confirm a diagnosis as well as to determine what goes into a treatment plan.

Does the patient simply need to rehabilitate their foot? Will a simple icepack do the trick? Do they need to take medicine or get injected with something in their foot? Or do they require surgery? These are just some of the questions that you can answer based on the results of this test and others.

It can be used to monitor patients as part of a routine check-up.

Let’s say your patient is undergoing rehabilitation or treatment for their foot/feet. You can conduct this test again to check if there are any changes in their feet, specifically if pulling back their big toe while the foot is dorsiflexed shows an increase in tension in the Plantar Fascia and if the arch of the foot rises and becomes more pronounced. If that’s the case, that means they have improved since the first time you conducted this test. If not, then perhaps the rehabilitation plan needs to be tweaked a bit.