Homan's test is used to assess for which condition when pain is felt in the calf on dorsiflexion?

• A. Deep vein thrombosis
• B. Calf strain
• C. Compartment syndrome
• D. Muscle edema

Answer: (A)

Pain in the calf elicited by passive dorsiflexion of the foot historically points toward a deep venous thrombosis in the leg. The idea is that forcing the ankle into dorsiflexion stretches the contents of the posterior calf, including the deep veins, and irritation or inflammation from a thrombus can produce pain. This is why the sign has been used to screen for DVT.

However, this maneuver is not reliable on its own. Sensitivity and specificity are poor, so a negative or positive Homan’s sign cannot confirm or exclude DVT. Modern evaluation relies on duplex ultrasound of the leg veins, with D-dimer testing in appropriate patients to guide further workup.

Other conditions described would not typically produce the calf-pain-on-dorsiflexion pattern. A calf strain involves the muscle-tendon unit and usually presents with focal tenderness along the muscle belly and pain with resisted plantarflexion or sprinting. Compartment syndrome presents with severe, out-of-proportion pain, tense swelling, and pain on passive stretching, often with neurovascular changes. Muscle edema is a radiologic finding rather than a clinical sign used to diagnose a specific acute condition.

So, the sign points to deep vein thrombosis, though it should be interpreted in the broader clinical context and confirmed with appropriate imaging.