Ankle Special Tests

Anterior Drawer Test 

Steps

• Athlete is sitting over the edge of the table with the knee bent 
• Examiner stabilizes the lower leg with one hand & cups the calcaneus with the forearm supporting the foot in slight plantar flextion (~ 20° ) and slight inversion (few degrees) 
• Examiner draws the calcaneus & talus anteriorly and slighlty medially 

Positive Test
Pain, anterior translation, dimple/sulcus, and/or "clunk"

Positive Test Implications
ATF ligament sprain/capsular sprain

Heel Tap ("Bump") Test 

Steps

• Athlete is sitting or lying supine, with the involved foot off the end of the table & the knee straight 
• Examiner stabilizes the lower leg with one hand & bumps the calcaneus with the other hand 
• Examiner bumps the calcaneus 2–3 times with progressively more force 

Positive Test
Pain (at area of complaint)

Positive Test Implications
Possible fracture

Tinel's Sign Test 

Steps

• Athlete is supine with the hip of the affected side externally rotated and the foot slightly everted 
• Examiner taps over the tarsal tunnel 

Positive Test
Radiating pain in the foot and toes

Positive Test Implications
Tarsal tunnel syndrome

Thompson's Test 

Steps

• Athlete is prone with his/her knee extended 
• Examiner squeezes the calf musculature while observing for ankle plantar flexion 

Positive Test
Foot does not plantar flex when calf is squeezed

Positive Test Implications
Achilles tendon rupture

Side–to–Side Test 

Steps

• Athlete is sitting (or supine with the knee slightly flexed) 
• Examiner stabilizes the lower leg with one hand 
• Examiner grasps the rearfoot and slides the talus/calcaneus laterally and medially 

Positive Test
Pain; noticeable "clunk"

Positive Test Implications
Syndesmosis sprain

Percussion Test 

Steps

• Athlete is sitting with the involved leg off the end of the table 
• Examiner taps distally from the involved structure 

Positive Test
Pain (at the area of complaint only)

Positive Test Implications
Possible fracture

Navicular Drop Test 

Steps

• Athlete is sitting with both feet on the floor 
• Examiner places a dot over the navicular tuberosity with the athlete in a non–weight bearing position 
• Examiner kneels in front of the athlete & places the subtalar joint in the neutral position with the athlete's foot flat against the ground, but non–weight bearing 
• Examiner positions a 3x5 index card next to the medial longitudinal arch & makes a mark on the card corresponding to the level of the navicular 
• Examiner has the athlete stand with his/her body weight evenly distributed & marks the new level of the navicular on the card 
• Examiner measures the distance between the two marks 

Positive Test
Navicular drops more than 10 mm

Positive Test Implications
Hyperpronation of the foot

Kleiger's (External Rotation) Test 

Steps

• Athlete is sitting with his/her legs over the edge of the table 
• Examiner stabilizes the lower leg with one hand 
• Examiner grasps the medial aspect of the foot while supporting the ankle in neutral 
• Examiner rotates the foot laterally 

Positive Test
Medial/lateral joint pain; syndesmosis (anterior Tib–fib) pain

Positive Test Implications
Deltoid ligament sprain (medial/lateral joint pain); syndesmosis involvment (syndesmosis/tib–fib pain)

Inversion Talar Tilt Test 

Steps

• Athlete is sitting with his/her legs over the edge of the table 
• Examiner grasps the calcaneus with one hand & stabilizes the lower leg with the other hand 
• Examiner provides inversion stress rolling the calcaneus inward while the ankle is in neutral 
• Examiner provides an inversion stress by rolling the calcaneus inward while the ankle is in the plantar flexed position 

Positive Test
Talus tilts or gaps excessively; pain

Positive Test Implications
Involvement of ATF (PF position)/CF (neutral position)

Eversion Talar Tilt Test

Steps

• Athlete is sitting with his/her legs over the edge of the table
• Examiner grasps the calcaneus with one hand & stabilizes the lower leg with the other hand
• Examiner provides an eversion stress rolling the calcaneus outward while the ankle is neutral

Positive Test
Talus tilts or gaps excessively; pain

Positive Test Implications
Deltoid ligament sprain

Homan's Sign Test

Steps

• Athlete is sitting or supine with the knee extended
• Examiner passively dorsiflexes foot while knee is extended
• Examiner palpates the calf

Positive Test
Calf pain

Positive Test Implications
Deep vein thrombophlebitis (DVT)