Windlass test
- Fysiobasen
- Oct 3
- 3 min read
The Windlass Test is used to evaluate the function of the plantar fascia and to identify possible plantar fasciitis. The test is based on the windlass mechanism, which explains how the plantar fascia supports the medial longitudinal arch of the foot during loading【1】.
By directly stretching the plantar aponeurosis, the test provides valuable insight into the biomechanical stresses on the plantar fascia and is clinically useful for both diagnosis and treatment planning.
The Windlass Mechanism
The windlass mechanism was first described by Hicks, who compared the foot’s structures to a truss system:
Calcaneus, midfoot, and metatarsals form the arch.
Plantar fascia acts as a “cable” stretched between the calcaneus and phalanges.
When the great toe is dorsiflexed, the plantar fascia tightens around the metatarsal head, shortening the distance between calcaneus and metatarsals, and raising the medial arch【2】.
Test Procedure
The Windlass Test can be performed in both non-weight-bearing and weight-bearing positions.
Non-Weight-Bearing Version【5】【6】【7】
Patient position: Sitting with knee flexed at 90° and foot relaxed.
Examiner’s position: One hand stabilizes the ankle behind the first metatarsal head, the other passively extends the first metatarsophalangeal (MTP) joint.
Technique: The interphalangeal joint is allowed to flex, preventing restriction from a tight flexor hallucis longus.
Interpretation:
Positive: Heel pain reproduced at end-range dorsiflexion.
Negative: No pain provoked.
Weight-Bearing Version【5】【6】
Patient position: Standing on a step, with metatarsal heads placed at the edge. Weight is evenly distributed.
Examiner’s action: Passively dorsiflexes the first MTP joint to end-range or until pain occurs.
Interpretation:
Positive: Heel pain reproduced.
Negative: No pain during dorsiflexion.
Diagnostic Value and Evidence
Research shows that the weight-bearing version of the Windlass Test has higher diagnostic accuracy than the non-weight-bearing version:
Weight-bearing Windlass Test: A positive result strongly indicates plantar fasciitis, with both sensitivity and specificity reported as extremely high【5】【6】.
Non-weight-bearing version: Low sensitivity (32%) means a negative result does not rule out plantar fasciitis.
Clinical Relevance
The Windlass Test is useful for:
Confirming plantar fasciitis in patients with heel pain.
Evaluating plantar fascia biomechanics under load.
Supporting clinical reasoning in rehabilitation and orthotic prescription.
However, because plantar fasciitis can have multiple contributing factors (e.g., overuse, obesity, foot posture), the test should always be combined with:
Palpation of the plantar fascia.
Functional assessment of gait and arch mechanics.
Imaging if symptoms are persistent or atypical.
Conclusion
The Windlass Test is a simple and reliable clinical assessment for plantar fascia function and plantar fasciitis. The weight-bearing version offers the highest diagnostic value, while the non-weight-bearing version has limited sensitivity. To ensure accuracy, the Windlass Test should be performed alongside other clinical tests and imaging studies when needed..
Sources
Bolgla LA, Malone TR. Plantar fasciitis and the windlass mechanism: a biomechanical link to clinical practice. Journal of athletic training. 2004 Jan 1;39(1):77.
Hicks JH. The mechanics of the foot, II: the plantar aponeurosis and the arch. J Anat. 1954;88:25–30
Amendola A. Physical Examination of the Foot and Ankle. Musculoskeletal Physical Examination E-Book: An Evidence-Based Approach. 2016 Jul 27:199.
Cole C. et al. ,Plantar fasciitis: evidence-based review of diagnosis and therapy, Am Fam Physican, 2005;73(11);2237-2242,2247-2248.
MC Poil T.G., Clincal Guidelines, Heel- Pain, Plantar Fasciitis, journal of orthopaedic and sports physical therapy, 2008, A1-A19.
De Garceau D, Dean D, Requejo SM, Thordarson DB. The association between diagnosis of plantar fasciitis and Windlass test results. Foot Ankle Int.2003;24:251-255.
Wong M., Pocket Orthopaedics: Evidence-Based Survival Guide(2010),Mississauga, Jones and Barlett Publishers, (p. 361).
