Garbrecht, Erika L

Johnson, Paul J

Miller, Richard A

Polander, Taylor J

Price, Amber L

English

University of New Mexico

72 EDUCATION ARTICLES • UNMORJ VOL. 7 • 201872
Simulated Method to Perform the Coleman 
Block Test in Educating Orthopaedic 
Residents Outside of the Clinic
Taylor J. Polander, MD; Erika L. Garbrecht, MD; Amber L. Price, MD; 
Paul J. Johnson, MD; Richard A. Miller, MD
Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, 
Albuquerque, New Mexico
Corresponding Author Richard A. Miller. Department of Orthopaedics & Rehabilitation, MSC 10 5600, 1 University of 
New Mexico, Albuquerque, NM 87131 (email: rmiller@salud.unm.edu).  
Funding The authors received no financial support for the research, authorship, and publication of this article.
Conflict of Interest The authors report no conflicts of interest.
Informed Consent The participant (senior author, RAM) was informed that the data concerning his case would be 
submitted for publication, and he provided verbal consent.
ABSTRACT
The Coleman block test is an important examination 
performed on patients with a cavovarus foot deformity. 
Unfortunately, resident physicians in orthopaedic 
programs have limited exposure to patients with this 
deformity. Few residents witness the Coleman block 
test, and it is difficult to understand without observing. 
We devised a method to simulate a cavovarus foot 
to instruct orthopaedic residents on performing the 
test. A 2-cm wedge was placed beneath the medial 
metatarsals to simulate the plantar-flexed first ray seen 
in a cavus foot. The position of the lift tilted the heel 
into varus owing to the tripod effect. The Coleman 
block test was then performed. Comparison of the heel 
positions before and after use of the test provided 
clear demonstration of the Coleman block test. 
Furthermore, residents can practice performing the test 
without a patient. The Coleman block test can then be 
demonstrated for teaching purposes. 
Keywords: Foot Deformities, Medical Education, 
Physical Examination.
INTRODUCTION
Cavovarus feet are characterized by a high arch and 
varus position of the heel. Symptoms include recurrent 
sprains, lateral-sided foot pain, and metatarsalgia. 
Cavovarus feet may develop without a known cause or 
because of a neurological disorder such as the Charcot-
Marie-Tooth disease. Cavus develops owing to relative 
plantar flexion of the first ray, which causes the heel to 
tip into varus with weight bearing because of the tripod 
effect. This varus heel deformity eventually can become 
more pronounced as stabilizing structures stretch 
and the peroneal tendons develop more pathological 
features. The heel varus can become fixed. The Coleman 
block test helps determine the flexibility of this heel 
deformity.1 
The Coleman block test was described by Sherman 
Coleman, MD, and William Chestnut, MD in 1977.2 The 
test is used on patients with a cavovarus foot deformity 
to determine whether the hindfoot varus deformity is 
fixed or flexible, and the result helps guide the type 
of orthotic device and operative treatment needed. If 
the hindfoot varus deformity is flexible, a dorsiflexion 
osteotomy of the first ray can be performed. If it 
is fixed, a lateral closing wedge osteotomy of the 
calcaneus is also required.3 We devised a method to 
perform the Coleman block test for educational use in 
orthopaedic residency programs. 
METHODS
During the Coleman block test, the foot is placed on a 
block high enough to avoid touching the ground when 
placing the plantar-flexed first metatarsal over the 
block’s edge. The medial metatarsals are placed off the 
edge while the rest of the foot remains on the block. 
This way, the plantar-flexed first metatarsal cannot tilt 
the foot into varus. If the heel deformity corrects while 
weight bearing during this maneuver, the deformity is 
flexible. If the heel deformity does not correct, there is a 
fixed hindfoot deformity.
In the current study, a 2-cm wedge was created out 
of any firm material (we used rubber wrapped with 
coband). The wedge was 2-cm high, 9-cm long, and 
5-cm wide. The wedge was placed beneath the first 
metatarsal of a volunteer (senior author, RAM) with 
a normal and flexible foot. The wedge was held using 
coband or tape wrapped about the foot (Figure 1). 
RESULTS
When the participant stood, the wedge tended to 
tilt the heel into a more varus position as seen when 
viewed from behind (Figure 2). Figure 3 shows this 
wedge in position from a medial-side view. A large 
73EDUCATION ARTICLES • UNMORJ VOL. 7 • 2018 73
amount of varus was not seen because of the ability 
of the metatarsal-cuneiform joint to dorsiflex in our 
participant’s healthy foot. Also, our participant did not 
have a chronic heel deformity, and secondary structures 
such as the subtalar ligaments only allowed limited 
motion. Compared to the position in Figure 2, the 
position of the heel obtained during the Coleman block 
test (Figure 4) provided a successful demonstration. 
Notably, the heel returned to a position of slight valgus 
during the test, signifying a flexible deformity. 
DISCUSSION
Performing and interpreting results of the Coleman 
block test can be difficult concepts to understand. 
Orthopaedic residents may not be exposed to many 
patients with cavovarus foot deformities; subsequently, 
residents may not see the test performed often during 
their training. 
The commonly used Orthobullets website currently 
poses five questions pertaining to the Coleman block 
test.4 Those questions have 3946 responses, of which 
only 2853 (72%) have been correct. The percentage 
of correct responses for each individual question 
ranges from 56% to 78%. Furthermore, questions about 
the Coleman block test are occasionally seen on the 
Orthopaedic In-Training Examination (OITE). In 2016, 
the OITE had two questions about the Coleman block 
test. 
Figure 1. The wedge placed beneath the first metatarsal, 
simulating a cavus foot.
Figure 2. The position of the heel in slight varus while 
weight bearing with the lift in place.
Figure 3. Medial view of the wedge in position. 
Figure 4. Restoration of normal heel valgus during the 
Coleman block test, consistent with a flexible deformity.
74 EDUCATION ARTICLES • UNMORJ VOL. 7 • 201874
The Coleman block test is a necessary examination to 
learn during orthopaedic residency, yet it is performed 
infrequently and can be difficult to understand. The 
simulation method described in this paper allows 
orthopaedic residents to witness the Coleman block 
test without a patient, learn how to perform the test, 
and interpret subsequent results.  
REFERENCES
1. Younger AS, Hansen ST Jr. Adult cavovarus foot. 
 J Am Acad Orthop Surg. 2005;13(5):302-315.
2. Coleman SS, Chesnut WJ. A simple test for hindfoot 
flexibility in the cavovarus foot. Clin Orthop Relat Res. 
1977;(123):60-62. 
3. Leeuwesteijn AE, de Visser E, Louwerens JW. 
Flexible cavovarus feet in Charcot-Marie-Tooth 
disease treated with first ray proximal dorsiflexion 
osteotomy combined with soft tissue surgery: a short-
term to mid-term outcome study. Foot Ankle Surg. 
2010;16(3):142-147. doi: 10.1016/j.fas.2009.10.002.
4. McKean J. Cavovarus foot in pediatrics & adults. 
Orthobullets website. https://www.orthobullets.com/
pediatrics/4063/cavovarus-foot-in-pediatrics-and-
adults. Accessed November 28, 2017. 


Simulated Method to Perform the Coleman Block Test in Educating Orthopaedic Residents Outside of the Clinic

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Simulated Method to Perform the Coleman Block Test in Educating Orthopaedic Residents Outside of the Clinic

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