Coleman block test

The Coleman Block Test is a clinical examination used to determine whether a cavovarus foot deformity (high arch with heel varus) is flexible or rigid. The test was first described in 1977 by Sherman Coleman and William Chestnut. It provides valuable information for treatment planning, such as the use of orthoses or surgical correction. Its advantages include being simple to perform, requiring minimal equipment, and providing a quick clinical indication. A limitation, however, is that it only assesses a static situation and should therefore be combined with other clinical tests for a comprehensive evaluation.

Background and Purpose

In cavovarus deformity, the condition is often due to a plantarflexed first metatarsal, which may cause the heel to tilt inward (varus) under load. The purpose of the Coleman Block Test is to determine whether this heel deformity corrects when the first metatarsal is removed from weight-bearing. This helps the clinician assess whether the deformity is flexible or rigid, and thereby decide on the most appropriate treatment.

Execution of the Test

• The patient stands barefoot with the lateral portion of the foot placed on a block that is high enough to prevent the first metatarsal from contacting the ground

• The first metatarsal hangs freely off the edge of the block so it does not influence heel position

• The remainder of the foot bears weight normally on the block

• The clinician observes the position of the heel under load

Interpretation of Results

• Flexible deformity: If the heel corrects to a neutral position (no varus) during the test, this indicates a flexible hindfoot deformity. In such cases, treatment is often conservative, such as orthoses designed to correct the alignment

• Rigid deformity: If the heel remains in varus during the test, this indicates a rigid deformity, which may require surgical correction

Evidence Base and Clinical Relevance

The Coleman Block Test is supported by Level 5 evidence, meaning it is primarily based on expert opinion and case reports. Nevertheless, it is recommended for evaluating patients with cavovarus foot deformity, for example in Charcot-Marie-Tooth disease. The test should always be used as part of a thorough clinical examination and interpreted in the context of the patient’s symptoms and overall findings.

Sources:

1. Polander TJ, Garbrecht EL, Price AL, Johnson PJ, Miller RA. Simulated Method to Perform the Coleman Block Test in Educating Orthopaedic Residents Outside of the Clinic. UNM Orthopaedic Research Journal. 2018;7(1):22.