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Forefoot Plantarflexion Test

Forefoot Plantarflexion Test: The Forefoot Plantarflexion Test is a very useful clinical test which I invented about 20 years ago to diagnose causes of dorsal midfoot pain, including Dorsal Midfoot Interosseous Syndrome (DMICS). I first described the pathological condition, DMICS, in my February 1997 Precision Intricast Newsletter (Kirby KA.: Foot and Lower Extremity Biomechanics: A Ten Year Collection of Precision Intricast Newsletters. Precision Intricast, Inc., Payson, Arizona, 1997, pp. 165-168). The Forefoot Plantarflexion Test opens up the dorsal midfoot joint surfaces which increases the tension force in the dorsal midfoot ligaments. If these dorsal midfoot ligaments are inflamed or damaged, or, more commonly, if the dorsal cortical margins of these midfoot joints have stress reactions within them, then the pulling force on the dorsal midfoot ligaments which attach to these injured dorsal margins of the midfoot joints will be painful in the Forefoot Plantarflexion Test. To perform the Forefoot Plantarflexion Test, have the the patient sit on the exam table. Then the examiner should cup the posterior calcaneus and pull the calcaneus towards them to stabilize the foot on the tibia. The other hand of the examiner is used to next grasp the medial or lateral dorsal forefoot, with the thumb dorsally and fingers plantarly in the medial arch. The forefoot is then plantarflexed on the rearfoot to place a tension force on the dorsal joint ligaments of the midfoot joints. The Forefoot Plantarflexion Test is normally negative when there is no midfoot pathology in the patient. However, the Forefoot Plantarflexion Test will be considered positive if the patient reacts with pain with plantarflexion of the forefoot on the rearfoot. A positive Forefoot Plantarflexion Test indicates either dorsal capsular ligamentous injury in the midfoot joints and/or subperiosteal bone injury at the dorsal midfoot joint surfaces where the capsular ligaments are attached. The Forefoot Plantarflexion Test is always positive in Dorsal Midfoot Interosseous Compression Syndrome (DMICS) and is always positive with midfoot crush injuries and with Lisfranc’s joint injuries. The Forefoot Plantarflexion Test also is helpful at objectively determining healing from midfoot joint injuries. The test can be modified by using variations in locations in manual pressure on the dorsal forefoot so that each individual metatarsal ray or a group of metatarsal rays may be tested simultaneously. The Forefoot Plantarflexion Test was first described in: Kirby KA: “Prescribing Better Foot Orthoses: Lateral-Dorsal Midfoot Pain”, June 2010 Precision Intricast Newsletter, Payson, AZ, 2002.