Alshami Ali M, Babri Awais S, Souvlis Tina, Coppieters Michel W
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
Foot Ankle Int. 2007 Apr;28(4):499-505. doi: 10.3113/FAI.2007.0499.
Plantar heel pain may result from several conditions such as tarsal tunnel syndrome (TTS) and plantar fasciitis. The dorsiflexion-eversion test is used to diagnose TTS, whereas the windlass test is used for plantar fasciitis. Given the similarity between both tests, the purpose of this study was to evaluate whether these tests are able to selectively load the structures which they aim to examine.
Both tests were evaluated in six cadavers by measuring strain in the plantar fascia, tibial nerve, lateral plantar nerve (LPN), and medial plantar nerve (MPN) using miniature displacement transducers. Longitudinal excursion of the nerves was measured with a digital caliper.
With the dorsiflexion-eversion test, dorsiflexion and eversion of the ankle in combination with extension of the metatarsophalangeal (MTP) joints significantly increased strain in the tibial nerve (+1.1%), LPN (+2.2%), and MPN (+3.3%) but also in the plantar fascia (+1.2%) (all: p=0.016). Both components (dorsiflexion-eversion and MTP extension) resulted in significant increases. With the windlass test, extension of all MTP joints significantly increased strain in the plantar fascia (+0.4%, p=0.016), but also in the tibial nerve (+0.4%, p=0.016), LPN (+0.8%, p=0.032) and MPN (+2.0%, p=0.016). Excursion of the nerves was always in the distal direction but only reached significance for the tibial nerve (6.9 mm, p=0.016) and LPN (2.2 mm, p=0.032) during the dorsiflexion-eversion test.
Both tests mechanically challenge various structures that have been associated with plantar heel pain. This questions the usefulness of the tests in the differential diagnosis of plantar heel pain.
足跟足底疼痛可能由多种病症引起，如跗管综合征（TTS）和足底筋膜炎。背屈-外翻试验用于诊断TTS，而绞盘试验用于诊断足底筋膜炎。鉴于这两种试验的相似性，本研究的目的是评估这些试验是否能够选择性地加载它们旨在检查的结构。
通过使用微型位移传感器测量足底筋膜、胫神经、足底外侧神经（LPN）和足底内侧神经（MPN）的应变，在六具尸体上对这两种试验进行评估。用数字卡尺测量神经的纵向偏移。
在背屈-外翻试验中，踝关节的背屈和外翻与跖趾（MTP）关节的伸展相结合，显著增加了胫神经（+1.1%）、LPN（+2.2%）和MPN（+3.3%）的应变，但也增加了足底筋膜（+1.2%）的应变（所有p=0.016）。两个组成部分（背屈-外翻和MTP伸展）均导致显著增加。在绞盘试验中，所有MTP关节的伸展显著增加了足底筋膜（+0.4%，p=0.016）的应变，但也增加了胫神经（+0.4%，p=0.016）、LPN（+0.8%，p=0.032）和MPN（+2.0%，p=0.016）的应变。神经的偏移始终是向远端方向，但仅在背屈-外翻试验期间，胫神经（6.9 mm，p=0.016）和LPN（2.2 mm，p=0.032）的偏移达到显著水平。
两种试验均对与足跟足底疼痛相关的各种结构产生机械性刺激。这对这些试验在足跟足底疼痛鉴别诊断中的实用性提出了质疑。
