Coleman Block Test

What is the Coleman Block Test?

Coleman Block Test is used to identify the flexibility of the hindfoot during the stance phase in cavovarus deformity. It’s first described by Sherman Coleman in 1977.

See Also: Foot Anatomy

How to do the Coleman Block Test?

The patient is standing.

This test is done by placing an approximately 2.5-cm (1 inch) wooden block laterally and medially:

• The lateral block test involves placing wooden blocks of varying height beneath the heel and the lateral margin of the foot. The blocks are placed according to the severity and shape of the foot deformity so as to allow the first metatarsal to reach the floor.
• In the medial block test, the wooden block must be placed beneath the first metatarsal head.

The height of the block can be increased to avoid the first metatarsal from weight-bearing and affecting the hindfoot.

What does a positive Coleman Block Test mean?

The block test is a good method for determining the flexibility of compensatory hindfoot deformities in the presence of simultaneous flexed forefoot contractures.

The lateral block test is used to determine the flexibility of a varus hindfoot deformity in the presence of a simultaneous valgus forefoot contracture. A flexible compensatory varus hindfoot deformity will be corrected by the lateral block (The position of the hindfoot goes from varus to valgus on weight-bearing if it is flexible and is best observed from behind).

Where a varus forefoot contracture is present, the medial block test will allow evaluation of the flexibility and/ or severity of the contracture in the hindfoot deformity.

See Also: Metatarsus Adductus

Modified Coleman Block Test

Mosca described the modified Coleman block test to assess the hindfoot flexibility in a cavovarus foot, and it avoids the awkwardness of the Coleman block test in which the child attempts to balance the foot on the block.

Here a 2.5-cm block is placed under the lateral two or three metatarsal heads. The heel remains on the ground, and the medial metatarsal heads reach for the ground as the forefoot pronates of the block.

Other Tests

Other tests for foot deformities include:

Foot Flexibility Test

Foot Flexibility Test assesses rigid or flexible talipes planovalgus deformity.

Talipes planovalgus is a foot deformity in which the medial longitudinal arch of the foot is flattened ( fatfoot, talipes planus, or pes planus) and the valgus position of the heel is increased (talipes valgus). The feet are examined from the side and from behind with the patient standing in the normal position and on tiptoe.

Persistent flattening of the medial longitudinal arch and persistent valgus position of the heel when the patient stands on tiptoe indicate a rigid talipes planovalgus deformity. In a flexible talipes planovalgus deformity, the tiptoe stance will bring about a varus shift in the heel to compensate for the valgus deformity, and the medial longitudinal arch will reappear.

Forefoot Adduction Correction Test

Forefoot Adduction Correction Test is used for assessment and differential diagnosis of rigid and flexible pes adductus (talipes varus).

The child is supine. The examiner grasps the foot of the affected leg with one hand and attempts to correct the pes adductus deformity by pressing on the medial aspect of the forefoot with thumb of the other hand.

Where this maneuver readily moves the forefoot across the midline and eliminates the pes adductus, the deform it y is usually flexible and will be spontaneously corrected. A deformity that cannot be passively corrected is a rigid pes adductus.
Congenital pes adductus deformities that resist manual correction will require rigorous timely treatment in corrective plaster casts.

References

• Coleman SS, Chesnut WJ. A simple test for hindfoot flexibility in the cavovarus foot. Clin Orthop Relat Res. 1977 Mar-Apr;(123):60-2. PMID: 852192.
• Mosca VS. Principles and management of pediatric foot and ankle deformities and malformations. Philadelphia, PA: Wolters Kluwer/ Lippincott Williams & Wilkins, 2014.
• Clinical Tests for the Musculoskeletal System 3rd Edition.