Paediatric: Silfverskiold test: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Paediatric: Silfverskiold test

Sample item

A child with spastic diplegia has equinus. Ankle dorsiflexion is limited with the knee straight but improves markedly when the knee is flexed. Which structure is tight, and which operation is suited?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Gastrocnemius; gastrocnemius recession

The Silfverskiold test compares ankle dorsiflexion with the knee extended and flexed. Flexing the knee relaxes the gastrocnemius, which crosses the knee, so improved dorsiflexion shows isolated gastrocnemius tightness. A gastrocnemius recession is then appropriate, while equal restriction in both positions means soleus involvement and need for tendo-Achilles lengthening.

Option by option

  • A. Tibialis posterior; transfer

    The tibialis posterior is not assessed by this test.

  • B. Soleus; tendo-Achilles lengthening only

    Equal restriction in both positions would indicate soleus tightness.

  • C. Gastrocnemius; gastrocnemius recession (correct)

    Correct. Improvement on knee flexion indicates gastrocnemius tightness.

  • D. Plantar fascia; fasciotomy

    The plantar fascia is not related to ankle dorsiflexion with knee flexion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Gastrocnemius; gastrocnemius recession. The Silfverskiold test compares ankle dorsiflexion with the knee extended and flexed.

Why is "Tibialis posterior; transfer" not the answer?

The tibialis posterior is not assessed by this test.

Why is "Soleus; tendo-Achilles lengthening only" not the answer?

Equal restriction in both positions would indicate soleus tightness.

Why is "Plantar fascia; fasciotomy" not the answer?

The plantar fascia is not related to ankle dorsiflexion with knee flexion.

What concept does this question test?

It tests Paediatric: Silfverskiold test in Orthopaedics. Flexing the knee relaxes the gastrocnemius, which crosses the knee, so improved dorsiflexion shows isolated gastrocnemius tightness. A gastrocnemius recession is then appropriate, while equal restriction in both positions means soleus involvement and need for tendo-Achilles lengthening.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric: Silfverskiold test?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.