Coleman Block Test, Foot, Hindfoot, Positive & Negative Results, Reverse Test, Wheeless

Coleman Block Test:

• What is Coleman Block Test?
• Foot & Hindfoot Assessment
• Positive & Negative Results
• Reverse Coleman Block Test
• Wheeless Orthopedic Reference

What is Coleman Block Test?

The Coleman Block Test is a clinical orthopedic examination used to evaluate hindfoot flexibility and alignment, particularly in patients with cavovarus or high-arched foot deformities. It helps determine whether the hindfoot varus is flexible (correctable) or rigid (fixed), guiding treatment decisions. The test is simple, non-invasive, and provides valuable diagnostic insight into the structural mechanics of the foot.

This test is named after Dr. William Coleman and is commonly used in both pediatric and adult orthopedic evaluations. It is particularly relevant in conditions like Charcot-Marie-Tooth disease, idiopathic cavovarus deformities, and neuromuscular disorders. By assessing how the hindfoot realigns when the forefoot is supported, clinicians can decide whether surgical correction should target the forefoot, hindfoot, or both.

Foot & Hindfoot Assessment

In the Coleman Block Test, the patient stands with the lateral side of the foot (including the heel and lateral forefoot) resting on a small wooden block, typically 2–3 cm thick. The medial forefoot (first metatarsal head) is left unsupported, allowing it to drop downward if flexible. This setup isolates the contribution of the forefoot to overall foot alignment.

The test primarily evaluates the relationship between the forefoot pronation and hindfoot varus. If the hindfoot corrects to a neutral or valgus position when the first ray is unloaded, the deformity is considered flexible and forefoot-driven. If the hindfoot remains in varus despite the block, the deformity is rigid, and correction will likely require hindfoot intervention. Thus, this test plays an essential role in determining the mechanical source of deformity.

Positive & Negative Results

A positive Coleman Block Test indicates that the hindfoot remains in varus when the first ray is unloaded, suggesting a rigid hindfoot deformity. This means the deformity originates from the hindfoot itself and will not correct with forefoot adjustments. In such cases, surgical or structural correction of the hindfoot may be required.

A negative Coleman Block Test occurs when the hindfoot realigns to neutral or valgus after unloading the first ray. This finding suggests that the hindfoot varus is flexible and secondary to a plantarflexed first ray or forefoot deformity. In these patients, conservative management or surgical correction directed at the forefoot is often sufficient. In both cases, accurate interpretation of the result is crucial for tailoring treatment plans.

Reverse Coleman Block Test

The Reverse Coleman Block Test is a variation used to assess the flexibility of hindfoot valgus deformities instead of varus. In this method, the patient stands on the medial side of the foot (first metatarsal and heel) on a block, leaving the lateral forefoot unsupported. This setup evaluates whether the valgus deformity is flexible or rigid.

If the hindfoot corrects to neutral when the lateral side is unloaded, the deformity is flexible and typically forefoot-driven. If it remains in valgus, the deformity is rigid and originates from the hindfoot. This reverse test is less commonly performed than the standard Coleman Block Test but can be equally valuable in comprehensive hindfoot assessments, especially in cases of flatfoot or valgus deformity.

Wheeless Orthopedic Reference

According to Wheeless’ Textbook of Orthopaedics, the Coleman Block Test remains a cornerstone in the clinical evaluation of cavovarus feet. Wheeless describes the procedure as a reliable method to distinguish between flexible and rigid hindfoot deformities, emphasizing its importance in surgical planning. The test helps determine whether correction should focus on the forefoot (e.g., dorsiflexion osteotomy of the first metatarsal) or the hindfoot (e.g., calcaneal osteotomy).

Wheeless also notes that accurate observation during the test is key. The clinician should assess the patient’s standing alignment from behind, focusing on heel orientation relative to the leg. Understanding Coleman Block Test principles, as outlined in Wheeless and other orthopedic resources, ensures precise diagnosis and guides both conservative and operative treatment strategies for complex foot deformities.