Execution
- 1Position the patient sitting or supine with the knee extended or comfortably supported.
- 2Passively move the ankle into maximal dorsiflexion and eversion.
- 3Extend the metatarsophalangeal joints as fully as tolerated.
- 4Hold the position for approximately 5 to 10 seconds.
- 5Ask whether pain, numbness, or paresthesia is reproduced in the tarsal tunnel distribution.
Positive outcome
Reproduction of tibial-nerve-distribution symptoms is positive. The test tensions and compress the posterior tibial nerve beneath the flexor retinaculum. Local stretch without paresthesia should be interpreted cautiously.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Kinoshita et al. (2001) | NA | 82 | NA | NA | NA |
| Alshami et al. (2007) | mechanistic validity study | NA | NA | NA | NA |
CommentKinoshita reported high symptom reproduction in tarsal tunnel syndrome, but specificity and independent replication are limited. The test is useful when symptoms are neural and plantar, especially if Tinel is equivocal. It can also provoke plantar fascia tension, so symptom quality matters.
Moderate Clinical Value