Ankle - Special Test

Question 1

Neutral Subtalar Positioning

Answer 1

purpose: Assess subtalar joint alignment and mobility - Identifies abnormal rearfoot to forefoot positioning

perform: Patient prone with feet off table. Examiner palpates talus and moves foot to find neutral where talar bulge is symmetrical.

positive: 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

Question 2

Anterior Drawer Test (Ankle)

Answer 2

purpose: Anterior talofibular ligament (ATFL) integrity

perform: Patient seated or supine with ankle in ~20° plantarflexion. Stabilize tibia and pull calcaneus anteriorly.

positive: Excessive anterior translation or soft end-feel = ATFL sprain

Question 3

Talar Tilt Test

Answer 3

purpose: Assess integrity of calcaneofibular ligament (CFL) or deltoid ligament

perform: 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

positive: Increased tilt or pain = ligament injury

Question 4

External Rotation Stress Test (Kleiger’s)

Answer 4

purpose: Assess syndesmosis injury or deltoid ligament

perform: Patient seated, knee flexed to 90°. Examiner stabilizes leg and externally rotates foot while ankle is neutral or dorsiflexed.

positive: Pain over anterior ankle (syndesmosis) or medial ankle (deltoid) = positive

test is positive for a syndesmosis (“high ankle”) injury if pain is produced over the anterior or posterior tibiofibular ligaments and the interosseous membrane

Question 5

Squeeze Test of the Leg

Answer 5

purpose: Syndesmotic sprain (high ankle sprain)

perform: Patient seated or supine. Examiner squeezes tibia and fibula together mid-calf.

positive: Pain distally at syndesmosis = positive

Question 6

Thompson Test

Answer 6

purpose: Achilles tendon rupture

perform: Patient prone with feet off table. Examiner squeezes calf muscle.

positive: Absence of plantarflexion = Achilles rupture

Question 7

Tinel’s Sign (Ankle)

Answer 7

purpose: Tarsal tunnel syndrome / tibial nerve irritation

perform: Tap posterior to medial malleolus over tibial nerve.

positive: Tingling or paresthesia in sole of foot = positive

Question 8

Morton’s Test

Answer 8

purpose: Morton’s neuroma or stress fracture (typically between 3rd and 4th metatarsals)

perform: Patient seated or supine. Examiner grasps foot and squeezes metatarsal heads together.

positive: Pain or burning sensation in forefoot = positive