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Wednesday, April 29, 2020

Hintermann Test or First Metatarsal Raise Test for Recognition of Posterior Tibial Tendon Dysfunction

     Hintermann published a paper in 1996 about a clinical test to help him decide whether a patient needed surgery for posterior tibial tendon dysfunction. It was based on the fact that with the patient standing, when the heel is inverted (or the leg externally rotated), only in the 21 patients that had posterior tibial disease (not necessarily ruptures) was this test positive for leaving the first metatarsal off the ground. It is now known more as the First Metatarsal Raise Test. When I read the article many thoughts crossed my mind, and I need to do this test some, but I need other podiatrists to give me feedback on their successes and failures. So, what bothered me about this test? The things that bother me are:

  1. 100% of the patients were positive even though the surgical findings were all over the place (from tendinitis only to complete ruptures)
  2. 100% of the patients without post tibial tendon disease were negative, but they do not go into any of these patients (allow they implied the test was being done over 4 years)
  3. They made no reference to what type of orthotics were being used preop to avoid surgery and whether the tendon being strengthened thoroughly before (there was no mention about posterior tibial strength at all)
  4. They seem to have no knowledge of deformities like rearfoot varus, rear foot valgus, forefoot valgus and forefoot varus. Any of these common deformities would greatly affect this test. 
  5. In most of my patients with PTTD, with 10 degrees of heel eversion, and 10 degrees of positional forefoot supinates, when I put the patient into heel varus the first metatarsal is going to be way off of the ground. This does not mean I need to do anything but rehabilitate them. 

I am so hopeful that my esteemed colleagues around the world will help decipher the importance of this test. 

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