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What is a Hick's Test? Is there a Hick's Test?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by bonbons*n*candies, Aug 13, 2008.

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    I'm a pod student trying to research on Hick's Test, but has found no luck.
    What is a Hick's Test? How do you do it? Why do you do it?
    Can someone pls help me out??
  2. Craig Payne

    Craig Payne Moderator

  3. Em3

    Em3 Member

    I'm a third year pod student in Queensland with a similar plight to bonbons*n*candies. An assessment this semester is to devise our own data capture sheets for a biomechanical examination. We've been given the task to help us sort out what's relevant, what's useful and what's reproducible when it comes to the tests and, if we can, what tests multiple things so we're optimising our time.

    I've been looking for the Hick's test over today and I've come up with very little, which would leave me thinking that I'm just horrendous at researching if it wasn't such a common name in the related literature.
    My tutor tells us it's a bona fide biomech exam that isn't Jacks or Huebscher's Maneuvre and has promised to tell us what it is before the assignment is due, though it's frustrating to not turn up any information aside from Hicks' involvement in founding the idea of the windlass mechanism.
  4. DaVinci

    DaVinci Well-Known Member

    I have never heard of it either. I did a quick Google search. Don't you think that if it was a bona fide biomech exam test, then it would at least show up on a Google search with at least one mention?

    When your tutor tells you what it is, come back and tell us what it is.
  5. Em3

    Em3 Member

    I was certainly hoping to get a nudge in the right direction with Google when I didn't find anything on a couple of database checks, but alas, no luck.

    I'm looking forward to finding out what it is, that's for sure! I hope to get back to you soon.
  6. Good... I feel like I am not insane then. ;)
    It's not the Jack's Test~ and apparently it has something to do with testing the 1st ray.
    When I find out what it is, I shall make a report on it :drinks
  7. David Smith

    David Smith Well-Known Member


    Perhaps your tutor means test in terms of experimental test and how data was gathered for this.
    See Below


    In this test you would require data tables to recorde the ranges of motion of interest and in terms of their displacement ie either angular or linear or time or some combination of these.

    Just a guess

  8. I have never heard of a "Hicks test". I have read all of the papers by John Hicks, who is one of my favorite researchers of the early years. Tell your tutor I said that instead of making students look high and low for "tests" that virtually no one knows of or are known by another name, that he or she should have podiatry students spend their valuable time learning about the more important tests that we do use and are commonly recognized within the international podiatric medical community.

    I have never understood this type of behavior in teachers/tutors. I think that some teachers/tutors just do this sort of thing to podiatry students because they either have an evil streak or because they have an inferiority complex.:confused:
    Last edited: Aug 13, 2008
  9. :D:butcher::D;)

    I have to say somewhere in a dark corner of my memory lurks the words "Hicks test". But I couldn't tell you what it is- I do suspect it is something to do with windlass function. Can't wait to find out. But rather than the students coming back here to tell us what it is, don't you think it would be much more fun for the lecturer to explain to us?:boxing:

  10. Simon:

    Haven been a podiatry student myself about a quarter century ago, and having memories of similar personalities that taught me at that time, I don't have a lot of patience with such behavior in teachers/tutors. Yeah...bring in the tutor and let him/her explain to all of us what the "Hicks test" is and have him/her show us where it is described within the medical literature.
  11. Secret Squirrel

    Secret Squirrel Active Member

    When the "big" boys don't know what it is, then it really does mean we do not know what it means. Its probably a test someone has made up.
    Lets ...
  12. nick_700

    nick_700 Active Member

    I completed my Honours degree last year at La Trobe. My thesis focussed on 1st MTPJ function, and so I did a lot of reading on Hicks and Bojsen-Moller. I never came across anything called a Hicks test.

    Can't wait to find out what it is
  13. Em3

    Em3 Member

    It is indeed a daunting prospect that very established professionals don't know what the test is. It makes it feel more like a wild goose chase.

    However...I've managed to track down a paper that a fellow student photocopied from the journals in the library and the Hicks Test is apparently testing the stiffness of the first ray. Activating the Windlass mechanism by dorsiflexing the first MTP joint and then moving the first ray through its active range of motion.

    As to what constitutes a positive or negative result, I'm not entirely sure, but at least I've found this tidbit of information. When the tutor tells us the test and its meanings in its entirety, I'll be sure to let you know.

    Though I do know that this tutor reads through the forums, anonymously, just lurking and watching the responses. If you feel like piping up, I'd be very grateful
  14. Em3

    Em3 Member

    For interest's sake, the reference was from the Journal of the Foot and Ankle Volume 42, Number 6, Nov/Dec 2003, Hypermobility of the First Ray: A Critical Review of the Literature by Thomas S Rankis and Adam S Landsman.
    And I apologise for the incorrect format of the reference, though I'm sure if you're interested in finding it, I've provided all of the necessary information.
  15. Ian Linane

    Ian Linane Well-Known Member


    Having trained, originally, via a none registered route, I was introduced to the term "Hicks test" which seemed to be the process that Dave S described in his post.

    I always, subsequently, understood this to be thought of as Hicks test until I came across terms such as the "Jacks test" on Pod Arena.

    Silly me, I thought the Jacks Test might have been a more modern version :wacko:

    :)empathy: Image of senior members looking sympathetically upon a far from learned and understanding Pod. ;))

    Could it be a simple transposing of names over the years - chinese whisper type stuff?

  16. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    Splendid - this is as good as the Loch Ness Monster - does it or does it not really exist. I look forward to the final explanation - if there really is one ? Greetings from rain-soaked Ireland.

  17. Foot Traffic

    Foot Traffic Member

    The suspense is more intense than the Olympic swimming finals!!

    I get all the way to the bottom of the thread and I'm still left hanging....

    Will be checking in tomorrow for the answer. Looking forward to impressing the staff with a new test to add to the repertoire

  18. jb

    jb Active Member


    A tribute to the late, great Bill Hicks; surely analysis of his blood was complex enough to deserve its own title.

    My two sense
  19. efuller

    efuller MVP

    I don't think we should jump on her instructer so quicklly. Having presented the biomechanical evaluation to students I think it is really a good idea to think critically about what measures should be included in the eval. Now, it could be the instructor is lazy. I would suggest a better assignment for students is to take an existing eval sheet and find literature to support the validity of those measures. Or to ask the students how they would alter the prescription in their patient's orthotics based on the measuements they take. Thinking critically is a good thing. Some guidence of students is also a good thing.


    Eric Fuller
  20. Maybe I have a different view of how an instructor should teach podiatry students from others on this forum, but, as a student, I didn't want a teacher to say, go out and find it on your own. To me, this made me feel as if the instructor was just....lazy........ or just liked to give students "busy-work".

    I much preferred the instructor say something to me like, here is the way I do it, this is the way others do it also, and here are the papers you should read in order to learn more about this subject. Then the really good instructors would also tell the student that they will expected to read some of these better paper(s) on the subject and we will be discussing or testing on the paper(s) in a week once you have had time to read the paper. This is efficient teaching, in my opinion.

    Having a student going out and trying to find some nebulous test that very few podiatrists know of, to me, is busy work. This is not even close to being efficient teaching. In addition, I consider this type of "mission of wasted time" assignment to podiatry students to be unacceptable behavior for a podiatry instructor.

    Better teachers produce better podiatrists.
  21. Adrian Misseri

    Adrian Misseri Active Member

    If your patient comes presents to your clinic in old flip-flops, a ratty old flannelette shirt and has a mullett haircut, I believe that to be a positive Hick test.....
  22. Em3

    Em3 Member

    Not to be an precocious, but universities have changed an awful lot since your time spent on the learning end. Students don't simply take their tutors advice to "read this article about this test" and come back for a discussion a week later, it becomes a one on one between a handful of students and the tutor while the others simply watch on, not actively learning or seeking the information.
    The tutor is actually one of the most helpful and resourceful teachers we have and while his method may not be kosher or acceptable to older, more established standards it does take into account the laziness of some students.

    The tutor justified the fact that he doesn't want to simply hand us the tests and the articles because he wants us to learn how to do that ourselves, as well as to encourage everybody to learn about it instead of that small handful. It is just this one Hicks test that is proving particularly unobtainable. I can understand the fors and against for both methods, but for the moment, being a curious person, I'm perfectly happy and eagerly learning under this tutors methods.
  23. Mr. Em3:

    Thanks for making me feel much older than I really am.

    By the way, I still am learning and I have been teaching podiatrists and podiatry students for 25 years. Does that make me less of an expert on the subject, or more of an expert on the subject, Mr. Em3??
  24. Em3

    Em3 Member

    Mr Kevin Kirby,

    It is no problem, Kevin, and it is an unfortunate fact of life that people grow older and I can make many of my own cohort feel 'old' purely from my year of birth, as will this next generation soon make me feel 'old'.
    We're all entitled to our opinions, the learned, the learning and the uneducated. I was merely accounting for the fact that I am a young university student learning many of these concepts for the very first time while you are a well-established professional that has seen, learned, unlearned then discovered new theories and practices.

    Perhaps you are able to instil the fear of the gods in your students, but it isn't the only way to teach students, or people in general. They often appreciate being treated as prospective-equals on a hard learning-curve.
    Also, I am curious, why would you assume that I was a mister?

  25. Mark Denman

    Mark Denman Welcome New Poster

    Hi all,

    First post so here goes...

    It seems to be referred to as the "Dynamic Hicks Test", at least in the article on Hypermobility of the First Ray: by Roukis and Landsman in 2003 in the Journal of Foot and Ankle Surgery, Vol 42 (6) 377-390 (bottom page 383 onto 384 with photos to demostrate and a 2nd reference on page 386). This article was referred to by Em3 earlier.

    The Authors cite a presentation of the test at the 5th international Conference on Foot Biomechanics and Orthotic Therapy, October 12, 2002, Montreal.

    The test is also cited by Blitz, N in Current Concepts in Medial Column Hypermobility, published in Podiatry Today, Vol 18 Issue 6 June 2005, pp68-79.

    Essentially the test is to maximally dorsiflex the hallux whilst dorsi and plantar-flexing the first MTPJ. i.e. test 1st Ray range of motion with the Hallux dorsiflexed.

    If not sure if it helps but thought I'd chip in.

    However, I doubt that..."this is as good as the Loch Ness Monster"( C.W. Kerans). The Loch Ness Monster is much more interesting!

    I would add to Adrian Misseri's post
    "If your patient presents to your clinic in old flip-flops, a ratty old flannelette shirt and has a mullett haircut, I believe that to be a positive Hick test..... "

    I generally look for the Bundy Rum sticker (or Jack Daniels sticker for our Nth American friends) on the bumper bar of the ute/pickup.
  26. Adrian Misseri

    Adrian Misseri Active Member

    I had a next door neighbour exactly liek this, complete with the stickered ute. His girlfriend has a ute almost the same. Scariest 6 months of my life.....

  27. Emma:

    Good to know your real name now, Emma.

    I am pleased to see a young podiatry student sticking up for what she believes in. Your opinion is very valuable on this academic forum and I hope you continue to contribute.:drinks
  28. admin

    admin Administrator Staff Member

    Not any more. This thread now shows as number one when searching Google for Hick's test (link)
  29. It's true, Prof. Kirby is getting older by the second, it's also true that he is the most unfrightening teacher I've ever had the pleasure to know. Since being in his presence makes one question everything you think you know about podiatric biomechanics. This is exciting, not fear instilling. Is there a God? While you are in his presence you may also be called upon to operate a radio controlled mouse, build paper aeroplanes, eat good food, drink good wines and tell jokes, laugh and have fun. A generous man both with his wallet and his company. But it's also true that I've learned more from him professionally than from any one other individual. I've argued with him many times; even won once or twice- ligaments don't generate force, Kevin :rolleyes: and rearfoot posting angles cannot be scientifically justified :bang: but he'd never admit that I was right :empathy: During the time I've known Kevin, I think that if anything he has over-estimated my abilities, regardless he has been a continual source of encouragement and inspiration and has seldom shown disappointment- even when it was due. In short, he has allowed me to understand more than I ever could without his teachings.

    I think I have a good understanding of educational theory having been a lecturer and Head of Podiatry School, so I understand the point being made here. We all have different learning styles, experiential learning, Carl Rogers blah blah blah whatever bull**** is in fashion this week etc. etc. etc. But take it easy on the old fella, he once mistook a pig for an antelope, bless him.

    Anyway that's enough gas up Kirby's ass for one night. BTW I for one look forward to the publication of the latest instalment of newsletters as I haven't been privy to the more recent ones since he stopped sending them to me because I'm not worthy anymore or something like that.... Hope to get a mention in the acknowledgements but, hey, you know, he's getting old, famous and out of touch.........

    Miss you old man.
  30. Em3

    Em3 Member

    To Kevin:

    Thank you. And you already knew my name - most of my friends call me Em :eek:


    To Simon:

    As a turn of phrase, the fear of the gods may just be the awe inspired by the mere presence of a great teacher, commanding from his students honour, respect and a certain reverence.
    And as I doubt it would be a good idea to start the open-discussion of "is there a god" - I won't touch that, it is a question for theologians!

    I have no doubt that Kevin may just be one of the best teachers you've had, but having yet to experience it and being somebody well apart from yourself, I'll take my chances, just as I'll "take it easy on the old fella" when he stops assuming somebody with an opinion is a guy, called "Em" ;) :D
  31. Emma:

    You may want to sign your name at the bottom of your posts if you want people to address you by the "right name". You will also find that by signing your real name at the bottom of your posts on Podiatry Arena that you will more readily ensure that someone will actually take the time out of their busy day to answer your posts.

    I do admire your spunk. Hope it translates to a successful professional career and great academic achievements for our profession in the future.
    Last edited: Aug 16, 2008
  32. Simon:

    Thanks for letting Ms. Em3 know that I'm not quite as scary of a guy as I may appear at times. My wife says I look pretty scary in the morning, but I didn't think that it translated over the internet quite so nicely.

    BTW, Simon, I'll send you those newsletters since you're still on my Birthday Party List.:drinks
    Last edited: Aug 16, 2008
  33. cab31

    cab31 Member

    Hey em,

    I found a similar thing last year - that at QUT they tend to try and separate the jacks test and the so called 'hicks' test,which i always argued was the same thing but were scored in different manners, for example a 'jacks test' (has been taught) the measure the amount of ease/force a clinician experiences in lifting the hallux (best done with a thin rigid polyprop piece to stabilise the DIPJ). What i thought was stupid with this is that there is so much subjectiveness between one person saying "it was really hard and could only get 10 degrees motion', and another would say "it was not overly hard but i couldnt get more than 10 degrees".
    From that i concluded they were the same thing and its better to look for the fascia tightening, the subsequent inversion and then the external rotation of the tibia. Having just the fascia is a one, having the fascia and then inversion is a two and having all three is a three. If you take this into account with relevant biomechanical findings and the actual presenting complaints you should be able to use this information to diagnose that there is an underlying functional hallux limitus.
  34. DaVinci

    DaVinci Well-Known Member

    Now we know what Hicks test is (and it seems its isolated to use at just one University), could someone actually explain what the test is used for, and more importantly, how does it actually affect clinical decision making?
  35. cab31

    cab31 Member

    I think em should ask her tutor exactly what the difference is between the two tests and whether or not one is more clinically signifigant or different from the other. I prefer to score using the jack's criteria but i think we should hear some feedback.
  36. Em3

    Em3 Member

    Absolutely, cab31, I believe that the tutors biggest beef with the Jack's test was the subjectivity, and from reading the articles that Mark provided earlier in the thread, I've come to *my* understanding that the dynamic Hicks is trying to emulate the weight-bearing capacity of the foot and exactly how structurally sound the first ray is (or its stiffness? Perhaps?).
    But having been unable to wrangle my much sought after answer, I'll be sure to let you know when I find out exactly what the difference is.

    Lastly, thank you, Kevin. And I will be sure to remember to use my name in future. Us teenagers and our confidence, I dunno ;) :D
  37. Gibby

    Gibby Active Member

    The "Hick's test" is a reference to the measurement of the windlass mechanism, generally encompassing the plantar fascial insertion mechanism and the relationship it has to development of digital contractures (I think you refer to this as 'clawtoe' deformity in Europe).
    An obscure reference I learned of in school... showing the relationship between plantar fascia, plantar metatarsal heads, and the predisposition to digital contractures. I am not aware of a quantitative measurement system.

    Being a Southern gentleman, I am more familiar with the Redneck/hillbilly explanation.

    Be well-
  38. David Wedemeyer

    David Wedemeyer Well-Known Member

  39. Em3

    Em3 Member

    Hahaha, that's beautiful, up there with Jungian and Freudian personality profiling.
  40. BRo

    BRo Welcome New Poster

    Here is the extract from the original article about the:


    BTW I do love the reference after the procedure is described

    Hypermobility of the first ray: a critical review of the literature

    Thomas S. Roukis DPM, AACFAS, , a, 1 and Adam S. Landsman DPM, PhD, FACFASa, 2

    a Reconstructive Foot and Ankle Surgery Service, Weil Foot and Ankle Institute, Des Plaines, IL, USA
    Available online 19 December 2003.

    Clinical evaluation of hypermobility: the dynamic hicks test
    The first ray clinical mobility test described by Root et al [4 and 55] involves placing the ankle and the STJ in their respective neutral positions (ie, ankle, lateral aspect of the foot 90° relative to the long axis of the leg; STJ, position in which the STJ is neither pronated nor supinated with the MTJ fully loaded) while 1 hand stabilizes the second through fifth metatarsal heads and the other hand stabilizes the first metatarsal head. In this position, the first metatarsal head is brought into full dorsiflexion and full plantarflexion; the range of motion in both directions is determined by comparing the position of the examiners fingernails dorsally and thumb nails plantarly (Fig. 1). Although Root et al [4 and 55] have not routinely been credited with developing this test, a detailed review of the literature shows that they, in fact, described this test in 1971 [55]. The next description of such a test outside of their own work [4] did not appear until 1991 when Klaue [21] described the exact same test in the German literature. Myerson et al [49] followed in 1992 in the English literature. Very few modifications of this test have been published since its inception [11, 22, 23 and 25].

    Full-size image (83K)

    FIGURE 1. The first ray clinical mobility test as described by Root et al [4 and 55]. With the ankle and STJ in their respective neutral positions, the first metatarsal head is brought into full dorsiflexion (A) and full plantarflexion (B) with the range of motion in both directions determined by comparing the position of the examiners’ fingernails dorsally and thumb nails plantarly, as indicated by the white lines. Fluoroscopic examination showing full dorsiflexion (C) and plantarflexion (D) of the first ray.

    View Within Article

    Polokoff [22] describes exerting equal pressure, in a dorsal direction, to the plantar aspect of the second metatarsal head and the first metatarsal head and compared the difference during a nonweightbearing examination of the foot. He considered any dorsal motion of the first metatarsal to be indicative of first ray hypermobility, and suggested that the examiner could differentiate between mild, moderate, and severe degrees of hypermobility with extensive clinical practice [22].

    Bednarz and Manoli [23], using the same technique as Root et al, [4 and 55] stated, “We feel that one full thumb breadth [dorsal to plantar] of dorsal motion of the first ray with the lesser rays stabilized is an indication that the first ray is hypermobile.”

    Wallace and Kilmartin [48] developed the “Kilmartin Sagittal Raynger,” which measures, in millimeters, the sagittal plane displacement of the first metatarsal head. This device is functionally similar to the one used by Lee and Young [15]. There has been no further description of the accuracy or reliability of this device.

    McInnes and Bouché [24] used Root et al’s [4 and 55] test and defined 3 types of position for the first ray: 1) parallel: the first and second metatarsal heads have a “level” starting position and equal dorsiflexory and plantarflexory excursion, 2) elevated: the first metatarsal’s starting position is superior to the second metatarsal and is able to dorsiflex to or above the dorsal aspect of the second metatarsal, and 3) plantarflexed: the first metatarsal’s starting position is inferior to the second metatarsal and is unable to dorsiflex past the plantar aspect of the second metatarsal.

    Voellmicke and Deland [25] describe performing Root et al’s [4 and 55] test with the examiners’ thumbs bent at the interphalangeal joints to 90°, which creates 2 visual reference lines along the dorsal surfaces of the proximal phalanges. The authors state that, “The distance between the plantar aspect of the first metatarsal head and that of the second is estimated utilizing the reference lines created by the thumb proximal phalanges” and suggest that this modification makes the estimation of sagittal plane distance easier than the original technique [25].

    The authors preferred technique to assess first ray mobility places the ankle and STJs in their respective neutral positions, while 1 hand stabilizes the second through fifth metatarsal heads and the other hand stabilizes the first metatarsal head. The hallux is fully dorsiflexed at the first MTPJ and a dorsally and plantarly directed force is applied to the first metatarsal head. This is similar to a portion of the indirect test for forefoot supinatus (ie, acquired soft-tissue inversion contracture of the forefoot on the rearfoot at the MTJ), as described by Roy and Scherer [63]. The resultant dorsal and plantar first ray motion as determined by this so-called “dynamic Hicks test” [26] is then compared with the first ray motion available, as determined through Root et al’s [4 and 55] first ray clinical mobility test (Fig. 2).


    Full-size image (56K)

    FIGURE 2. The dynamic Hicks test [26]. With the ankle and STJ in their respective neutral positions, the first metatarsal head is brought into full dorsiflexion and full plantarflexion (A) with the range of motion in both directions determined by comparing the position of the examiners’ fingernails dorsally and thumb nails plantarly, as indicated by the white lines. In this patient, there was no clinically appreciable difference between full dorsiflexion and full plantarflexion of the first ray. Fluoroscopic examination showing full dorsiflexion (C) and plantarflexion (D) of the first ray. Note that during full dorsiflexion the first metatarsal remained in a plantarflexed position. Compare with Fig. 1C and D.

    View Within Article

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