Hello Surgeon

X

How can we help you today?

Special Test

Silfverskiold Test

Silfverskiold Test is used to evaluate the contracture of the ankle joint whether it’s caused by gastrocnemius muscle contracture or by the Achilles tendon contracture. It measures the dorsiflexion of the foot at the ankle joint with knee extended and flexed to 90 degrees.

This test was first described by Nils Silfverskiöl in 1923.

How do you perform the Silfverskiold Test?

  • With the patient supine or seated, the examiner dorsiflexes the foot while the knee in full extension and measures the ankle dorsiflexion range.
  • Then the test is repeated with knee flexed at 90 degrees and the ankle dorsiflexion range is measured.
See Also: Thomas Test

What does a positive Silfverskiold Test mean?

Ankle movements are influenced by the position of the knee because gastrocnemius crosses both joints.

In gastrocnemius contracture, dorsiflexion of the ankle is limited with knee extension and more dorsiflexion of ankle is possible on knee flexion.

See Also: Homans Sign
Silfverskiold Test – Gastrocnemius Contracture
Silfverskiold Test – Gastrocnemius Contracture

In Achilles tendon contracture the dorsiflexion of the ankle remains the same irrespective of the position of the knee joint (flexion or extension).

In all patient with ankle joint contracture, one should assess the spine for deformity and range of motion.

Silfverskiold Test – Achille Contracture
Silfverskiold Test – Achilles Contracture
See Also: Ankle Range of Motion

Because the gastrocnemius originates from above the knee, it tightens when the knee is extended and relaxes when the knee is flexed. If the loss of dorsiflexion is because of gastrocnemius tightness alone, then there will be reduced dorsiflexion with the knee extended. If there is no change of ankle dorsiflexion with knee flexion or extension, then the contracture is in both gastrocnemius and soleus.

Accuracy

The Silfverskiöld test had poor inter- and intrarater reliability.

Reverse Silfverskiold test

Reverse Silfverskiold test is not very popular.

With knee in full extension (ankle dorsiflexion here is solely restricted by tendo-Achilles) measure the range of dorsiflexion at ankle (more on injured side compared to the normal side).

Notes

Do not use the plantar medial border as the presence of supination or pronation deformity of the forefoot will give false recording and values if missed.

Few authors suggest that the Silfverskiold test should be done with the foot held in inversion while assessing the foot and ankle. The inversion locks the foot and thereby eliminates instability of the hindfoot and midfoot joints.

Flatfoot presents a special challenge when assessing for contracture of the heel cord. The reason is that both the ankle joint and subtalar joint dorsiflex and plantarflex. To isolate ankle joint dorsiflexion, the subtalar joint is anatomically aligned or locked using inversion to prevent subtalar dorsiflexion. The cavus foot presents a challenge to assess the heel cord contracture. Assessment of ankle equinus is done by isolating the hindfoot. The forefoot can be obscured from vision with the hand so that only the hindfoot is visualized.

Gastrocnemius Muscle Anatomy

The gastrocnemius originates from above the knee by two heads, each head connected to a femoral condyle and to the joint capsule. Approximately halfway down the leg, the gastrocnemius muscles merge to form an aponeurosis. As the aponeurosis gradually contracts, it accepts the tendon of the soleus, a flat broad muscle deep to the gastrocnemius. The aponeurosis and the soleus tendon end in a flat tendon, called the Achilles tendon, which attaches to the posterior aspect of the calcaneus. The two heads of the gastrocnemius and the soleus are collectively known as the triceps surae.

Although the primary function of the gastrocnemius– soleus complex is to plantar flex the ankle and to supinate the subtalar joint, the gastrocnemius also functions to flex or extend the knee, depending on whether the lower extremity is weightbearing or not.

It has been proposed that weakness of the gastrocnemius may cause knee hyperextension. In addition, it has been theorized that the gastrocnemius acts as an antagonist to the ACL, exerting an anteriorly directed pull on the tibia throughout the range of knee flexion–extension motion, particularly when the knee is near extension.

Gastrocnemius Muscle Anatomy
Gastrocnemius Muscle Anatomy

Soleus Muscle

The Soleus Muscle arises from the head of fibula, proximal third of shaft, soleal line and midshaft of posterior tibia. It inserts onto Posterior surface of calcaneus through Achilles tendon. It’s innervated by the tibial nerve.

See Also: Ankle Anatomy

Achilles Tendon

The Achilles tendon is the thickest, strongest tendon in the body. As the Achilles tendon comes off the posterior calf muscles, it courses distally to attach approximately three-quarters of an inch below the superior portion of the os calcis, on the medial aspect of the calcaneus.

soleus Muscle Anatomy
Soleus Muscle Anatomy

References

  1. Symeonidis P. The Silfverskiöld Test. Foot Ankle Int. 2014 Aug;35(8):838. doi: 10.1177/1071100714535202. Epub 2014 Jul 30. PMID: 25080357.
  2. Baumbach SF, Brumann M, Binder J, Mutschler W, Regauer M, Polzer H. The influence of knee position on ankle dorsiflexion – a biometric study. BMC Musculoskelet Disord. 2014 Jul 23;15:246. doi: 10.1186/1471-2474-15-246. PMID: 25053374; PMCID: PMC4118219.
  3. DiGiovanni CW, Kuo R, Tejwani N, Price R, Hansen ST Jr, Cziernecki J, Sangeorzan BJ. Isolated gastrocnemius tightness. J Bone Joint Surg Am. 2002 Jun;84(6):962-70. doi: 10.2106/00004623-200206000-00010. PMID: 12063330.
  4. Fleiss DJ. Diagnostic tests for gastrocnemius tightness. J Bone Joint Surg Am. 2003 Apr;85(4):760; author reply 760. doi: 10.2106/00004623-200304000-00027. PMID: 12672856.
  5. Molund M, Husebye EE, Nilsen F, Hellesnes J, Berdal G, Hvaal KH. Validation of a New Device for Measuring Isolated Gastrocnemius Contracture and Evaluation of the Reliability of the Silfverskiöld Test. Foot Ankle Int. 2018 Aug;39(8):960-965. doi: 10.1177/1071100718770386. Epub 2018 Apr 20. PMID: 29676167.
  6. Clinical Assessment and Examination in Orthopedics, 2nd Edition Book.
  7. Millers Review of Orthopaedics -7th Edition Book.
Last Reviewed
May 22, 2023
Contributed by
OrthoFixar

Orthofixar does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice.

x
Orthopedic Approaches App
  • Price: 9.99 $
  • One year product updates
  • Install on one device
  • One year product support
One-Click Purchase
Orthopedic Classification App
  • Price: 9.99 $
  • One year product updates
  • Install on one device
  • One year product support
One-Click Purchase
Orthopedic Classification App
  • Price: 0 $
  • One year product updates
  • Install on one device
  • One year product support
One-Click Purchase
Physical Therapy Study
  • Price: 9.99 $
  • One year product updates
  • Install on one device
  • One year product support
One-Click Purchase
X

Join Our Telegram Channel

Join our Telegram channel to stay updated with the latest news and updates!

orthopedic-telegram-channel