Hello Surgeon

X

How can we help you today?

Special Test

Navicular Drop Test

The navicular drop test is a method used to assess the degree to which the talus plantar flexes in space on a calcaneus that has been stabilized by the ground, during subtalar joint pronation.

This test was introduced firstly by Brody in 1982 to assess the amount of foot pronation in runners.

See Also: Foot Anatomy

How do you do the Navicular Drop Test?

The clinician palpates the position of the navicular tubercle as the patient’s foot is non–weight-bearing but resting on the floor surface, with the subtalar joint maintained in neutral.

Navicular Drop Test
Mark the position of the navicular tubercle

The clinician then attempts to quantify the amount of inferior displacement of the navicular tubercle, as the patient assumes 50% weight-bearing on the tested foot (relaxed standing).

The two measurements are recorded.

Navicular Drop Test
Measuring the amount of droping of navicular tubercle

What is a positive Navicular Drop Test?

A navicular drop that is greater than 10 mm from the neutral position to the relaxed standing position suggests excessive medial longitudinal arch collapse of abnormal pronation.

Test Accuracy

Navicular Drop Test has been found to have an intratester reliability that ranged from ICC = 0.61 to 0.79 and intertester reliability of ICC = 0.57.

However, it is questionable whether a significant drop is also indicative of dysfunction.

Feiss Line Test

The Feiss line test is used to assess the height of the medial arch, using the navicular position.

Feiss Line
Feiss Line

With the patient non–weight-bearing, the clinician marks the apex of the medial malleolus and the plantar aspect of the first MTP joint, and a line is drawn between the two points. The navicular is palpated on the medial aspect of the foot, and an assessment is made of the position of the navicular relative to the imaginary line. The patient is then asked to stand with their feet approximately 3–6 inches apart.

Feiss Line Test
Feiss Line Test

In weight-bearing, the navicular normally lies on or very close to the line.

The degree of flatfoot deformity is defined as following:

  • If the navicular falls one-third of the distance to the floor, it represents a first-degree flatfoot;
  • if it falls two thirds of the distance, it represents a second-degree flatfoot;
  • if it rests on the floor, it represents a third-degree flatfoot.

No diagnostic accuracy studies have been performed to determine the sensitivity and specificity of this test.

Note

The navicular drop test, considered to be an estimate of the extent of pronation, assesses the change in navicular position between weight-bearing and non–weightbearing positions. Note that the body weight should be evenly distributed between the two feet.

Navicular height can be measured by making Navicular tuberosity while the patient is in weight-bearing
position. Distance from ground to navicular tuberosity is measured.

A strong relationship exists between excessive forefoot varus (>8°) and an increased navicular drop.

The low interrater reliability associated with the navicular drop test is related to the low reliability of assessing subtalar joint neutral. The height of the navicular in weight bearing (the second measurement of the navicular drop test) is highly correlated with radiographic measurements of navicular height in weight bearing.

References

  1. Shrader JA, Popovich JM Jr, Gracey GC, Danoff JV. Navicular drop measurement in people with rheumatoid arthritis: interrater and intrarater reliability. Phys Ther. 2005 Jul;85(7):656-64. PMID: 15982172.
  2. Staheli LT: Rotational problems of the lower extremity. Orthop Clin North Am 18:503–512, 1987.
  3. Mueller MJ, Host JV, Norton BJ. Navicular drop as a composite measure of excessive pronation. J Am Podiatr Med Assoc. 1993 Apr;83(4):198-202. doi: 10.7547/87507315-83-4-198. PMID: 8473991.
  4. Brody DM. Techniques in the evaluation and treatment of the injured runner. Orthop Clin North Am. 1982 Jul;13(3):541-58. PMID: 6124922.
  5. Piva SR, Fitzgerald K, Irrgang JJ, Jones S, Hando BR, Browder DA, Childs JD. Reliability of measures of impairments associated with patellofemoral pain syndrome. BMC Musculoskelet Disord. 2006 Mar 31;7:33. doi: 10.1186/1471-2474-7-33. PMID: 16579850; PMCID: PMC1557500.
  6. Rathleff MS, Nielsen RG, Kersting UG. Navicula drop test ad modum Brody: does it show how the foot moves under dynamic conditions? J Am Podiatr Med Assoc. 2012 Jan-Feb;102(1):34-8. doi: 10.7547/1020034. PMID: 22232319.
  7. Spörndly-Nees S, Dåsberg B, Nielsen RO, Boesen MI, Langberg H. The navicular position test – a reliable measure of the navicular bone position during rest and loading. Int J Sports Phys Ther. 2011 Sep;6(3):199-205. PMID: 21904698; PMCID: PMC3163999.
  8. PalmerML, Epler M: Clinical Assessment Procedures in Physical Therapy. Philadelphia, PA: JB Lippincott, 1990.
  9. Menz HB, Tiedemann A, Kwan MM, et al. Reliability of clinical tests of foot and ankle characteristics in older people. J Am Podiatr Med Assoc. 2003;93: 380-387
  10. Buchanan, KR, and Davis, I: The relationship between forefoot, midfoot, and rearfoot static alignment in pain-free individuals. J Orthop Sports Phys Ther, 35:559, 2005.
  11. Menz, HB, and Munteanu, SE: Validity of 3 clinical techniques for the measurement of static foot posture in older people. J Orthop Sport Phys Ther, 35:279, 2005.
  12. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
Angle Meter App for Android & iOS
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase
Orthopedic FRCS VIVAs Quiz
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase
Top 12 Best Free Orthopedic Apps
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase
All-in-one Orthopedic App
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase