A modified straight leg raising (SLR) in which ankle dorsiflexion is performed before hip flexion has been suggested to diagnose distal neuropathies such as tarsal tunnel syndrome. This study evaluates the clinical hypothesis that strain in the nerves around the ankle and foot caused by ankle dorsiflexion can be further increased with hip flexion. Linear displacement transducers were inserted into the sciatic, tibial, and plantar nerves and plantar fascia of eight embalmed cadavers to measure strain during the modified SLR. Nerve excursion was measured with a digital calliper. Ankle dorsiflexion resulted in a significant strain and distal excursion of the tibial nerve. With the ankle in dorsiflexion, the proximal excursion and tension increase in the sciatic nerve associated with hip flexion were transmitted distally along the nerve from the hip to beyond the ankle. As hip flexion had an impact on the nerves around the ankle and foot but not on the plantar fascia, the modified SLR may be a useful test to differentially diagnose plantar heel pain. Although the modified SLR caused the greatest increase in nerve strain nearest the moving joint, mechanical forces acting on peripheral nerves are transmitted well beyond the moving joint. ß

We studied the influence of different positions in neighboring joints on strain in the tibial and plantar nerves during ankle and toe movements. Tibial nerve strain at the ankle was measured during ankle dorsiflexion in ten cadavers; plantar nerve strain was measured during toe extension. Tibial nerve strain increased with ankle dorsiflexion (mean increase: 3.9%) and strain was higher when the nervous system was pretensioned by either knee extension or hip flexion (p ≤ .011). Strain was even higher when the nerve bed was elongated at both the hip and knee (p ≤ .006) before performing dorsiflexion. A similar trend was observed for the plantar nerves with ankle positioning. In conclusion, the change in nerve strain is strongly influenced by positions in neighboring joints. This insight into nerve biomechanics provides a foundation for progressive mobilization exercises for disorders such as tarsal tunnel syndrome.

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Both tests mechanically challenge various structures that have been associated with plantar heel pain. This questions the usefulness of the tests in the differential diagnosis of plantar heel pain.

Assessment partnerships between staff and students are considered a vital component of the student-centred educational process. To enhance the development of this partnership in a problem-based learning curriculum, all first-year students were involved in generating a bank of formative assessment questions with answers, some of which were included in their final written examination. Important principles to guide development of a sound methodology for such an assessment partnership have been described. These include organisational issues as well as matters pertaining to participation, education and motivation of students and teaching staff.