Execution
- 1Position the patient standing or sitting with the foot supported.
- 2Stabilize the first metatarsal or forefoot.
- 3Passively extend the great toe at the first MTP joint.
- 4Repeat in weight bearing because it is often more provocative.
- 5Ask whether plantar heel or medial longitudinal arch pain is reproduced.
Positive outcome
Reproduction of the patient's plantar heel or arch pain during passive great-toe extension is positive. The maneuver tensions the plantar fascia through the windlass mechanism. A negative test does not exclude plantar fasciitis.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| De Garceau et al. (2003) | NA | 31.8 | 100 | infinity | 0.68 |
CommentThe windlass test is very specific in De Garceau's study but poorly sensitive, so it is a rule-in sign when positive and a poor rule-out test when negative. The infinite LR+ results from 100% specificity and should be interpreted cautiously because of sample-size and spectrum limitations. History of first-step pain and focal medial calcaneal tubercle tenderness remain important.
Moderate Clinical Value