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I'm after some advice from the podopaediatrics specialists please...

I have a 15 year old female patient. No notable medical history, first presented 6months ago with medial knee pain bilaterally. Foot posture index of +7 bilaterally.

She had a positive Jack's test 6months ago (bilat). Now, on recent review, she has a positive Jack's test on the (R) foot, with medial arch raising nicely... but the (L) foot shows no change - even on a soft tissue level, with hallux dorsiflexion whilst standing.

Any ideas on why this has happened would be most welcome. (there's been no growth 'spurt' over the past 6months). Also any tx options too would be gratefully received.

Thanks

 

The only thing that I can thing of that would cause this would be a plantar fascia rupture! Is there anything else going on?

 

What exactly are the observations you make when you declare your patient has a "positive Jack's test"? What exactly happens to the foot now when you dorsiflex the hallux on the left foot?

 

Kevin... its an international difference thingy .... a "positive Jack's test" is a term I do not like, but it is just the arch coming up when hallux is dorsiflexed. ... also in North America its more commonly called the Hubscher manoeuvre. I don't like the term, as is it positive if the arch comes up or is it positive if the arch does not come up? (most mean positive when the arch comes up). Also what is the timing of the arch coming up (immediate or delayed) and how much force is needed ... etc etc.

 

Craig:

I know that you know what a positive Jack's test is.....but do we know that Kahuna knows this??:D

 

Has there been any rotational changes to the pelvis which may also be reflected in change to supination resistance as well?

 

You have to remember that there is a brain attached to the foot that you are treating. Some people will use their muscles to help move the foot when you attempt to dorsiflex the hallux. You can often see the posterior tibial tendon become more promenent when the muscle is contracting. Another clue is when you let go of the hallux and it stays up in the air with the EHL tendon being prominent.

Regards,

Eric

 

Thanks all for your replies.

First of all, I can clarify that I understand the term ' +tive jacks test' as described by Craig in his post... ie, "a 'positive Jack's test' is just the arch coming up when hallux is dorsiflexed."

To answer Kevin's question, the (L) foot shows a nice raise of the medial arch on hallux dorsiflexion, with a raise of the navicular.

[Normally, in resting calc stance, the midtarsal joint is very lax, with a very low arch and Navicular bisection 12mm below a line from the medial mall and pl 1st Met Head.]

The (R) foot previously had a nice raise of the medial arch on hallux dorsiflexion, with a raise of the navicular too... however now the hallux appears completely independent from windlass mechanism. It is very lax and effects no soft tissue change around the medial arch.

In response to Eric's post, there is no evidence of patient interaction/control during the test , ie, no prominent post tib tendon. And in response to "PodAus" there is no pelvic change during the recent exam.

Thx

 

Sounds like Craig said...a plantar fascial rupture. Now, to confirm it, do a simulated "Jack's test" with the patient non-weightbearing, dorsiflexing the hallux with the first metatarsal head loaded.....does this raise the arch any??

 

First demonstrate your between day reliability, then demonstrate the validity of your assessment. After that, identify predictors of a "positive Jacks Test"- within that list is the answer to your question- rule each of them in or out or changed/ unchanged.