Ankle Special Tests

Question 1

Anterior Drawer Test: response and implications

Answer 1

Checking ATFL (Anteior Talofibular ligament) 85% of the time that is the ligament that is injured

Question 1

Kleiger Test: response and implications

Answer 1

Deltoid. This is a corroborative test with the valgus stress test

Question 2

Anterior Impingement Test: how to perform

Answer 2

Starting position: pt sitting in dependent position. Sit on lateral side of patient’s leg. Can put pt’s leg right on yours.

Perform Test: Take proximal hand and put thumb right in area right above the sinus Tarsi. with your distal hand all you are going to do is dorsiflex the ankle.

Question 3

Kleiger Test: how to perform

Answer 3

Starting position: pt sitting in dependent position. Sit on lateral side of patient’s leg. Can put pt’s leg right on yours.

Perform Test: Take proximal hand and put thumb right in area right above the sinus Tarsi. Take your distal hand and grab over the dorsum of the mid foot. The thumb should be in the cuboid and the fingers on the navicular. Now go ahead and do an eversion stress test at the mid foot, which is pulling on the deltoid ligament. This is a corroborative test with the valgus stress test.

Question 4

Varus Stress Test: response and implications

Answer 4

CFL (calcaneofibular ligament – The second most commonly injured ligament in the ankle)

Question 5

Anterior Drawer Test: how to perform

Answer 5

Starting position: pt sitting in dependent position. Sit on lateral side of patient’s leg. Can put pt’s leg right on yours. Use distal hand and grab under the calcaneus and take proximal hand and put it over the distal tib-fib. Their foot needs to be resting on the volar surface of your forearm.

Perform Test: pull anteriorly to check the ATF. What you are trying to do is pull the talus out of the mortise.

Question 6

Valgus Stress Test: response and implications

Answer 6

Deltoid ligament

Question 7

Anterior Impingement Test: response and implications

Answer 7

Pain indicates a positive test
Scar Tissue from repeated sprains is implicated

Question 8

Posterior Drawer Test: response and implications

Answer 8

PTFL (Posterior Talofibular Ligament – rarely injured - the third of three to be injured)

Question 9

Valgus Stress Test: how to perform

Answer 9

Starting position: pt sitting in dependent position. Sit on lateral side of patient’s leg. Can put pt’s leg right on yours. Use distal hand and grab under the calcaneus and take proximal hand and put it over the distal tib-fib. Their foot needs to be resting on the volar surface of your forearm.

Tilt the leg in to frontal plain valgus/eversion (remember valgus is a frontal plane movement at the STJ [subtalar joint])

Question 9

Compression Test: how to perform

Answer 9

Pt in dependent position. You are sitting on lateral side of leg.

Swing your chair around now facing your partner’s leg, and start up at the proximal tib-fib. This should be about 3 or 4 compression distractions. The finally compression and distraction needs to be around the malleoli.

Question 10

Shuck Test: response and implications

Answer 10

Tests the Ankle Capsule. It is a generic test that is not very good

Question 11

Other name for Shuck Test

Answer 11

Cotton Test

Question 13

Other name for Cotton Test

Answer 13

Shuck Test

Question 14

External Rotation Test: how to perform

Answer 14

Starting position: pt sitting in dependent position. Sit on lateral side of patient’s leg. Can put pt’s leg right on yours.

Perform test: This is probably the hardest one to do.
Take your distal hand and put it underneath the calcaneus and put your forearm on the medial side of the foot. Take your proximal elbow and put it on the lateral side of your partner’s leg and your hand should be stabilizing over the distal tibia. Now go ahead and dorsiflex the ankle first and then hold the dorsiflexion and externally rotate the ankle. It won’t move very much because that is the closed packed position and what you are doing is forcing the talus to splay the fibula apart and that would be indicative of a diastasis or a syndesmotic injury to distal tib-fib (high ankle sprain). If there were a diastasis injury then this would hurt.

Question 15

Posterior Drawer Test: how to perform

Answer 15

Starting position: pt sitting in dependent position. Sit on lateral side of patient’s leg. Can put pt’s leg right on yours. Use distal hand and grab under the calcaneus and take proximal hand and put it over the distal tib-fib. Their foot needs to be resting on the volar surface of your forearm.

Push straight posteriorly to test the PTFL (posterior Talofibular Ligament, this is hardly ever injured)

Question 16

Compression Test: response and implications

Answer 16

Fracture or MTSS (medial tibial stress fracture)

If it hurts it could be shin splints, periostitis, fractures, etc.

You start all the way up near the fibular head which checks for a Maisonneuve fracture

Your last compression should be at the malleoli, and right above that is where you can get the Pott’s fracture.

When you compress it you are checking for a fracture and when you let go (the distraction phase) then that usually checks distally for a diastasis or syndesmotic injury. If the compression feels better and then you release it hurts then that is a positive for the diastasis or syndesmotic injury because as you release the mortise splays open which hurts.

That is a corroborative test external rotation test.

Question 17

Varus Stress Test: how to perform

Answer 17

Starting position: pt sitting in dependent position. Sit on lateral side of patient’s leg. Can put pt’s leg right on yours. Use distal hand and grab under the calcaneus and take proximal hand and put it over the distal tib-fib. Their foot needs to be resting on the volar surface of your forearm.

Tilt the leg in to frontal plain varus/inversion (remember varus is a frontal plane movement at the STJ [subtalar joint])

Question 18

Calcaneal Tap Test: how to perform

Answer 18

Starting position: pt sitting in dependent position. Sit on lateral side of patient’s leg.

Relax your top side hand and take your bottom hand and give 3 calcaneal taps.
You hit the bottom of the calcaneus to try and elicit a vibration. (Some people use tuning forks and a variety of different things.)

You are checking to see if it shows up a Pott’s fracture a Maisonneuve Fracture or a Jones Fracture. A positive is pain in the patient.

Question 20

Calcaneal Tap Test: response and implications

Answer 20

Stress Fractures

You are checking to see if it shows up a Pott’s fracture a Maisonneuve Fracture or a Jones Fracture. A positive is pain in the patient.

Question 21

Shuck Test: how to perform

Answer 21

Starting position: pt sitting in dependent position. Sit on lateral side of patient’s leg. Can put pt’s leg right on yours. Use distal hand and grab under the calcaneus and take proximal hand and put it over the distal tib-fib. Their foot needs to be resting on the volar surface of your forearm.

Perform Test: push side to side without tilting. It is a generic test that is not very good, but described in the literature.

Question 22

External Rotation Test: response and implications

Answer 22

Distal Tib-Fib Lig.

what you are doing is forcing the talus to splay the fibula apart and that would be indicative of a diastasis or a syndesmotic injury to distal tib-fib (high ankle sprain). If there were a diastasis injury then this would hurt.