Ankle Special Tests

Question 1

Neutral Subtalar

• Position
• Results
• Values

Answer 1

Identify abnormal rear foot or forefoot positioning.

• Prone with foot off table, DF to resistance, then pronate and supinate to find neutral. Compare rear and forefoot to leg.
• No SN or SP

Question 2

Anterior Drawer

• Position
• Results
• Values

Answer 2

ID laxity in ATFL

• supine, heel in 20° PL. Stabilize lower def and grasp foot, then pull talus anterior.
• (+) with excessive anterior glide and/ or pain
• SN 78, SP 75

Question 3

Talar TIlt

• Position
• Results
• Values

Answer 3

ID laxity in CFL, deltoid (kind of)

• side-lying, knee flexed and ankle neutral.
• Adduction for CFL, abduction for deltoid. (+) with excessive motion and/ or pain.
• SN 67, SP 75

Question 4

Thompson test

• Position
• Results
• Values

Answer 4

Evaluate integrity of achille’s tendon

• Prone, squeeze half muscle
• No movement = lack of integrity
• SN 40%, SP unknown

Question 5

Tinel’s Sign

Answer 5

ID dysfunction of posterior tibial N or deep fibular N

• tap over posterior tibial N posterior to medial mall
• tap over deep fibular N under dorsal retinaculum, anterior to ankle joint
• Reproduce tingling or paresthesia into N distributions
• SN 58 SP unknown

Question 6

Morton’s Test

Answer 6

ID stress fracture or neuroma in forefoot
- Supine, squeeze metatarsal heads
(+) pain in forefoot
- SN SP unknown

Question 7

Kleiger’s test

Answer 7

ID distal tibiofibular syndesmosis - high ankle sprain
- Seated edge of table, knee flexed to 90. Ever/DF force to foot.
(+) symptoms or joint gapping
- SN SP unknown

Question 8

Windlass

Answer 8

ID windlass effect of plantar fascia
-Standing for WB or sitting for NWB, passively extend first MTP joint.
(+) symptoms of plantar foot, end range for NWB
-SN 100, SP 32

Question 9

Ottawa Ankle Rules

Answer 9

To determine if imaging is necessary

Tenderness at: posterior lateral or medial mall, base of fifth MTP, navicular, inability to bear weight for 4 steps

Question 10

Bernese Ankle Rules

Answer 10

Ankle and mid foot fractures

Tenderness with: compression above lateral malleolus, medial malleolus, compression of mid foot on hind foot

Question 11

Homan’s sign

Answer 11

For DVT: passively extend knee and DF ankle
(+): pain in popliteal fossa or calf
false (+): calf strain or baker’s cyst

Not very sensitive or specific.