title: Neutral heel lateral push test: The first clinical examination of spring ligament integrity.
abstract: BACKGROUND
  The spring (calcaneonavicular) ligament is an intricate multiligament complex whose primary role is to stabilise the medial longitudinal arch and head of talus. Clinical suspicion of a spring ligament injury in isolation is roused when persistent medial midfoot pain is present with associated pes planus following trauma.
  
  
  METHODS
  We undertook a cadaveric study on 21 specimens to assess the use of a neutral heel lateral push test to examine the spring ligament in a standardised procedure, measuring lateral translation with graduated antegrade and retrograde defunctioning of surrounding structures and the spring ligament.
  
  
  RESULTS
  In all specimens, a significant displacement occurred on incision of the spring ligament regardless of order of dissection. The degree of displacement increased by an insignificant amount as surrounding structures were incised at each incremental force applied.
  
  
  CONCLUSIONS
  The neutral heel push test is the first clinical examination to be described to determine integrity of the spring ligament complex. Our study objectively demonstrates that lateral displacement in relation to the mid and hind-foot is influenced most significantly by the integrity of the spring ligament and to a lesser extent by tibialis posterior and flexor digitorum longus.
authors.affiliation: The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, United Kingdom; The Evelyn Cambridge Surgical Training Centre, Back Lane, Melbourn, Royston, Hertfordshire, England SG8 6DP, United Kingdom. Electronic address: cpasapula@yahoo.com.
authors.forename: Chandra
authors.initials: C
authors.lastname: Pasapula
authors.affiliation: The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, United Kingdom; The Evelyn Cambridge Surgical Training Centre, Back Lane, Melbourn, Royston, Hertfordshire, England SG8 6DP, United Kingdom. Electronic address: adamdevany@gmail.com.
authors.forename: Adam
authors.initials: A
authors.lastname: Devany
authors.affiliation: The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, United Kingdom; The Evelyn Cambridge Surgical Training Centre, Back Lane, Melbourn, Royston, Hertfordshire, England SG8 6DP, United Kingdom. Electronic address: ahmedmagan@gmail.com.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Magan
authors.affiliation: The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, United Kingdom; The Evelyn Cambridge Surgical Training Centre, Back Lane, Melbourn, Royston, Hertfordshire, England SG8 6DP, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Memarzadeh
authors.affiliation: The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, United Kingdom; The Evelyn Cambridge Surgical Training Centre, Back Lane, Melbourn, Royston, Hertfordshire, England SG8 6DP, United Kingdom.
authors.forename: V
authors.initials: V
authors.lastname: Pasters
authors.affiliation: Department of Trauma and Orthopaedics, Medway Maritime Hospital, Windmill Road, Gillingham ME7 5NY.
authors.forename: S
authors.initials: S
authors.lastname: Shariff
mesh_terms: D002102:Cadaver; D004210:Dissection; D018409:Foot Injuries / Q000175:diagnosis*; D006365:Heel; D006801:Humans; D008023:Ligaments, Articular / Q000293:injuries*; D008349:Manipulation, Orthopedic / Q000379:methods*; D016059:Range of Motion, Articular / Q000502:physiology*; D013640:Tarsal Joints / Q000503:physiopathology*
keywords: Cadaveric; Calcaneonavicular ligament; Examination; Flatfoot; Pes planovalgus; Spring ligament