Ankle Joint Special Tests Flashcards
Neutral Subtalar Positioning
PURPOSE- Identifies abnormal rearfoot to forefoot positioning
DESCRIPTION- Patient prone with foot over edge of the table. Palpate dorsal aspect of talus on both sides with one hand, and grasp lateral forefoot with other hand. Gently dorsiflex foot until resistance then gently move foot through arc of supination and pronation
RESULT- Neutral position is where you feel foot fall off easier to one side or other. At this point compare rearfoot to forefoot and rearfoot to leg.
Anterior Drawer Test
PURPOSE- Identify ligamentous instability
(particularly anterior talofibular ligament)
DESCRIPTION- The patient lies supine with the foot relaxed. The examiner stabilizes the tibia and fibula, holds the patient’s foot in 20° of plantar flexion, and draws the talus forward in the ankle mortise
RESULT- Positive test if talus has excessive anterior glide/ pain is noted
Talar Tilt Test
PURPOSE- To identify instability of calcaneofibular ligament.
DESCRIPTION- The patient lies in the supine or side lying position with the foot relaxed . The patient’s gastrocnemius muscle may be relaxed by flexion of the knee. The foot is held in the anatomical (90°) position, talus is then tilted from side to side into inversion and eversion.
RESULT:
Inversion tests the calcaneofibular ligament.
Eversion stresses the deltoid ligament
External Rotation Stress Test (AKA Kleiger Test)
PURPOSE- Evaluates syndesmosis injury and a tear of the deltoid ligament. Also known as Kleiger test.
DESCRIPTION- The patient is seated with the leg hanging over the examining table with the knee at 90°. The examiner stabilizes the leg with one hand. With the other hand, the examiner holds the foot in plantigrade (90°) and applies a passive lateral rotation stress to the foot and ankle.
RESULT- The test is positive for a syndesmosis (“high ankle”) injury if pain is produced over the anterior or posterior tibiofibular ligaments and the interosseous membrane.
If pain is present medially and the examiner feels the talus displace from the medial malleolus, it may indicate a tear of the deltoid ligament
Squeeze Test of The Leg
PURPOSE- To assess the syndesmosis integrity.
DESCRIPTION- The patient lies supine. The examiner grasps the lower leg at midcalf and squeezes the tibia and fibula together. The examiner then applies the same load at more distal locations moving toward the ankle.
RESULT- Pain in the lower leg may indicate a syndesmosis injury, provided that fracture, contusion, and compartment syndrome have been ruled out.
Thompson’s Test
PURPOSE- Evaluates integrity of Achilles tendon
DESCRIPTION- The patient lies prone or kneels on a chair with the feet over the edge of the table or chair. While the patient is relaxed, the examiner squeezes the calf muscles.
RESULT- The absence of plantar flexion when the muscle is squeezed indicates a positive test and a ruptured Achilles tendon (third-degree strain)
Tinel’s Sign
PURPOSE- Identifies dysfunction of posterior tibial nerve
DESCRIPTION-
The anterior tibial branch of the deep peroneal nerve may be percussed in front of the ankle.
The posterior tibial nerve may be percussed as it passes behind the medial malleolus
RESULT- In both cases, tingling or paresthesia felt distally is a positive sign.
Morton’s Test
PURPOSE- Identifies stress fracture or neuroma in forefoot
DESCRIPTION- The patient lies supine. The examiner grasps the foot around the metatarsal heads and squeezes the heads together.
RESULT- Pain is a positive sign for stress fracture or neuroma.
