What is Silverskiöld test?

Silfverskiöld Test: A Clinical Assessment for Gastrocnemius vs Soleus Tightness

Introduction

The Silfverskiöld Test is a valuable clinical examination tool used by physiotherapists, orthopedists, and other healthcare professionals to differentiate between tightness of the gastrocnemius and soleus muscles—both major contributors to ankle dorsiflexion. Proper assessment is crucial for diagnosing equinus deformity, gait abnormalities, or foot drop, especially in neurological and musculoskeletal conditions.

Purpose of the Test

The primary goal of the Silfverskiöld Test is to determine whether limited dorsiflexion at the ankle joint is caused by a contracture of the gastrocnemius muscle alone or by both the gastrocnemius and soleus muscles. This differentiation informs treatment strategies, including stretching protocols, orthotic intervention, or surgical release when necessary.

Anatomical Basis

The gastrocnemius and soleus together form the triceps surae muscle group. The gastrocnemius crosses both the knee and ankle joints, while the soleus only crosses the ankle. This anatomical distinction is essential in performing and interpreting the Silfverskiöld Test.

Patient Positioning

  • The patient is positioned supine or seated on the examination table.

  • The examiner ensures that the knee is first extended and then flexed during the test to isolate the function of each muscle.

Procedure

  1. With the Knee Extended:

    • The examiner dorsiflexes the ankle passively while the knee is fully extended.

    • Limitation in dorsiflexion here could indicate gastrocnemius tightness.

  2. With the Knee Flexed:

    • The knee is flexed to approximately 90 degrees, eliminating the gastrocnemius’ influence.

    • If ankle dorsiflexion improves, the limitation is isolated to the gastrocnemius.

    • If dorsiflexion remains restricted, the soleus is also tight.

Interpretation

  • Increased dorsiflexion with the knee flexed: Indicates gastrocnemius tightness.

  • No significant change in dorsiflexion: Suggests combined gastrocnemius and soleus tightness or soleus involvement.

Clinical Significance

This test is essential in various clinical scenarios, such as:

  • Cerebral palsy

  • Equinus deformities

  • Achilles tendinopathy

  • Plantar fasciitis

  • Flatfoot (pes planus)

Identifying the specific muscle involved helps determine whether conservative treatment (e.g., stretching) or surgical options (e.g., gastrocnemius recession) are appropriate.

Advantages

  • Quick and non-invasive.

  • Requires no specialized equipment.

  • Highly effective in differential diagnosis.

Limitations

  • Subjective interpretation; depends on examiner experience.

  • May be confounded by ankle joint pathologies or neurological conditions.

Conclusion

The Silfverskiöld Test remains a cornerstone in lower limb musculoskeletal assessments. By differentiating between gastrocnemius and soleus tightness, clinicians can customize therapeutic interventions more accurately, leading to improved patient outcomes in gait and mobility.

References

  1. Silfverskiöld N. (1924). Reduction of the uncrossed two-joint muscles of the leg to a one-joint muscle in spastic conditions. Acta Chir Scand, 56, 315-330.

  2. Tardieu C, et al. (1981). Muscle length and passive mechanical properties during the Silfverskiöld Test. Developmental Medicine & Child Neurology, 23(3): 343–350.

  3. Kolodziej L, et al. (2014). Evaluation of the Silfverskiöld Test in the surgical treatment of equinus deformity. Clinical Orthopaedics and Related Research, 472(3), 951–957.

  4. Physiopedia. Silfverskiöld Test. https://www.physio-pedia.com/Silfverskiöld_Test


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