Windlass Shield Test, A Novel Test for Detection of Plantar Fasciitis: A Proof of Concept Study on 45 Patients
Silvan Beeler, Arnd F. Viehöfer, Stephan H. Wirth
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Source: Crossref
Published: Oct 1, 2026
DOI: 10.1177/24730114261486025
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Background: We have observed that passive plantar fascia stretching via metatarsophalangeal joint dorsiflexion reduces palpation pain in plantar fasciitis. This diagnostic maneuver, the “Windlass Shield Test,” may differentiate subfascial from epifascial pain. This study evaluated its diagnostic utility in heel pain patients and compared outcomes with the traditional Windlass Test. Methods: This comparative study prospectively evaluated 45 patients with refractory heel pain. Exclusion criteria included systemic inflammatory diseases, radiculopathy, pregnancy, minor age, and prior foot surgery. Clinical findings and magnetic resonance imaging (MRI) defined the heel pain outcomes. Two independent readers used the Windlass Shield Test to measure diagnostic accuracy (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) and interrater reliability. Results: MRI confirmed plantar fasciitis in 33 patients (73%), whereas 12 (27%) had alternative conditions. Among those with plantar fasciitis, 76% experienced subfascial pain despite structural changes extending into the epifascial region. The Windlass Shield Test outperformed the conventional test in sensitivity (76% vs 18%), PPV (81% vs 67%), and NPV (43% vs 25%), although its specificity was lower (50% vs 75%). The test demonstrated moderate interrater reliability (Cohen κ = 0.601, 95% CI 0.354-0.848; P < .001). Conclusion: The Windlass Shield Test provides higher sensitivity but lower specificity than the conventional Windlass Test. This biomechanical difference suggests a subfascial, rather than epifascial, origin of pain. Consequently, a positive Windlass Shield Test yields a PPV of 81% for plantar fasciitis. Level of Evidence: Level IV, comparative study.
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