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Hello,

I know there are multiple threads discussing Jacks test/ Hubscher manoeuvre and its clinical importance but I need some assistance to where to find a source to reference the classification system. In all the papers I have come across they have described the test as either being positive or negative. However on non-academic sources and in clinical practice, we have been using the 0-3 grading system. For example below is one from a biomechanics course presentation online (the reference however did not mention anything about grading, but only positive and negative tests). I just don't know where it comes from.

0 : Nil, with high resistance. Marked FnHL. Not able to dorsiflex hallux
1: Slight Nil FnHL. Able to slightly dorsiflex hallux
2: Yes, with resistance Slight arch raising with limited external leg rotation Normal
3: Yes, with limited resistance. Complete arch raising with obvious external leg rotation and rearfoot inversion. Possible supinator

Anyone able to shed light on this? It isn't even my main masters question (Just one of the tests I did during data collection) but I've been sucked down the rabbit hole looking for it.

Thanks in advance,
Olivia

 

Never seen or heard of that classification before.
Assume it was made up by the person presenting the course.

There is nothing in that classification to do with timing of events, so not particularly useful.

 

Well if you haven't heard of it Craig I will just stick to positive and negative then. So strange since hearing about it 5-6 years ago, so many podiatrists use it...with apparently no source... thanks for taking your time to reply :)

 

Keep in mind that there are two parts to the test:
1. The force needed (which is in that classification above)
2. The timing when events happen (which is not in that classification)

Also, this is just based on a theoretical model of the windlass that is mostly supported by circumstantial evidence and very little direct evidence.
There is only limited data linking the outcome of any sort of classification to dynamic function and even less linking it to the outcome of clinical interventions based on it.

That does not mean that it does not have some good clinical usefulness and widely used.

 

Sorry, I can't help you with a source.

The rating scale is an attempt to put a discrete number to a continuous range of values. The resistance to hallux dorsiflexion in stance will be dependent upon many variables, force under the first metatarsal, external pronation moment, and the amount of moment contributed by muscle activation. There are some people, when you dorsiflex their hallux in stance, and then let go, who will remain for variable amounts of time, with their arch raised and hallux dorsiflexed. When that happens there will be signs of muscle activation. If the windlass were the only thing going on then the toe would immediately plantar flex and the arch would lower. This observation means that one should not put too much emphasis on the number on the scale. There is something important going on here. This is something that makes one foot different than another, but is this really the best way to measure it?

One thing left off of that scale is the internal leg and talar rotation described by Jack. The Hubscher maneuver was also called the push up test of Jack. -1?