Athletic Training & Sports Medicine Center

ANKLE STRESS EXAMINATION TESTS

TESTS	POSITION OF THE ANKLE	STRUCTURES INVOLVED	DESCRIPTION OF TEST BEING PERFORMED
Eversion Stress Medial Stress	Neutral plantarflexion to eversion	Deltoid Ligament	Knee is bent 90⁰ and gastrocnemius is relaxed. The heel is held from below by one hand while the other hand holds the lower leg. The hand on the heel is placed somewhat inferior medial and is used to push the calcaneus and talus into eversion while the other hand grips the lower leg laterally and pushes medially.
Side to Side Test Transverse Drawer Test	Neutral plantarflexion	Anterior and Posterior Inferior Tibiofibular Ligaments Interosseous Membrane	Knee is flexed 90⁰ and gastrocnemius is relaxed. Move the calcaneus and talus to each side as a unit. Do not tilt the ankle. If mortise is widened, the talus will be able to move sideways, producing a definite thud as it hits the fibula, and when moved in the opposite direction, it butts against the tibia.
Anterior Drawer	Slight plantarflexion	Anterior Talofibular Ligament Anteromedial Capsule	Knee is flexed 90⁰ and gastrocnemius is relaxed. One hand holds the lower tibia and exerts a slight posterior force, and the other hand is around the posterior aspect of the calcaneus and attempts to bring the calcaneus and talus forward on the tibia. Also done by stabilization of foot and talus on table and pushing tibia and fibula posteriorly.
Inversion Stress Lateral Stress	Neutral Plantarflexion 20⁰ Plantarflexion	Calcaneofibular Ligament Calcaneofibular Ligament and Anterior Talofibular Ligament	Knee is flexed 90⁰ and gastrocnemius is relaxed. The heel is held from below by one hand while the other hand holds the lower leg. The hand on the heel is placed somewhat inferior lateral and is used to push the calcaneus and talus into inversion while the other hand grips the lower leg medially and pushes laterally. Note an end point.
External Rotation Test Kleiger Test	From neutral to external rotation of foot	Anterior Inferior Tibiofibular Ligament Interosseous Membrane	Foot should be in neutral position with the lower leg stabilized. Examiner should then externally rotate the foot. If this causes pain then must consider a tear of the anterior tibiofibular ligament. Depending on severity the interosseous membrane may be involved. Pain will be at site of the anterior tibiofibular ligament.
Squeeze Test	Below head of fibular	Anterior Inferior Tibiofibular Ligament	Perform the squeeze test just above the anterior tibiofibular ligament. Squeeze the bones together firmly and slowly, hold and then quickly release. If there is pain upon release at the area of the anterior tibiofibular ligament, then a sprain of that ligament is highly suspected.
Squeeze Test	Up and down the shaft of the tibia and fibula. Foot is in a neutral, relaxed position.	Testing for fracture of tibia or fibular.	Place the heel of each hand at equal height on the shaft of the tibia and fibula, then push or squeeze the bones together. Pain above or below the sight of the squeeze is indicative of a fracture. Test should be repeated several times up and down the shafts of both bones.
Heel Tap Test	Foot is relaxed and in a neutral position	Tibia and Fibula	The foot is held relaxed by one hand in a somewhat neutral position, while the heel of the other hand is used to tap or lightly hit the bottom of the heel from an inferior to superior direction. Pain along the lower leg may indicate a fracture of the tibia or fibula.

ANKLE STRESS EXAMINATION TESTS

TESTS	POSITION OF THE ANKLE	STRUCTURES INVOLVED	DESCRIPTION OF TEST BEING PERFORMED
Eversion Stress Medial Stress	Neutral plantarflexion to eversion	Deltoid Ligament	Knee is bent 90⁰ and gastrocnemius is relaxed. The heel is held from below by one hand while the other hand holds the lower leg. The hand on the heel is placed somewhat inferior medial and is used to push the calcaneus and talus into eversion while the other hand grips the lower leg laterally and pushes medially.
Side to Side Test Transverse Drawer Test	Neutral plantarflexion	Anterior and Posterior Inferior Tibiofibular Ligaments Interosseous Membrane	Knee is flexed 90⁰ and gastrocnemius is relaxed. Move the calcaneous and talus to each side as a unit. Do not tilt the ankle. If mortise is widened, the talus will be able to move sideways, producing a definite thud as it hits the fibula, and when moved in the opposite direction, it butts against the tibia.
Anterior Drawer	Slight plantarflexion	Anterior Talofibular Ligament Anteromedial Capsule	Knee is flexed 90⁰ and gastrocnemius is relaxed. One hand holds the lower tibia and exerts a slight posterior force, and the other hand is around the posterior aspect of the calcaneus and attempts to bring the calcaneus and talus forward on the tibia. Also done by stabilization of foot and talus on table and pushing tibia and fibula posteriorly.
Posterior Drawer	Slight Plantarflexion	Posterior Talofibular Ligament	Knee is flexed 90⁰ and gastrocnemius is relaxed. One hand is placed on the heel to stabilize it while the other hand is placed on the posterior aspect of the lower leg. Attempt to bring the tibia forward on a fixed heel.
Inversion Stress Lateral Stress	Neutral Plantarflexion 20⁰ Plantarflexion	Calcaneofibular Ligament Calcaneofibular Ligament and Anterior Talofibular Ligament	Knee is flexed 90⁰ and gastrocnemius is relaxed. The heel is held from below by one hand while the other hand holds the lower leg. The hand on the heel is placed somewhat inferior lateral and is used to push the calcaneus and talus into inversion while the other hand grips the lower leg medially and pushes laterally. Note an end point.
External Rotation	From neutral to external rotation of foot	Anterior Inferior Tibiofibular Ligament Interosseous Membrane	Foot should be in neutral position with the lower leg stabilized. Examiner should then internally rotate the foot. If this causes pain then must consider a tear of the tibiofibular ligament. Depending on severity the interosseous membrane may be involved. Pain will be at site of the anterior tibiofibular ligament.
Squeeze Test	Below head of fibular	Anterior Inferior Tibiofibular Ligament	Perform the squeeze test just above the anterior tibiofibular ligament. Squeeze the bones together firmly and slowly, hold and then quickly release. If there is pain upon release at the area of the anterior tibiofibular ligament, then a sprain of that ligament is highly suspected.
Squeeze Test	Up and down the shaft of the tibia and fibula. Foot is in a neutral, relaxed position.	Testing for fracture of tibia or fibular.	Place the heel of each hand at equal height on the shaft of the tibia and fibula, then push or squeeze the bones together. Pain above or below the sight of the squeeze is indicative of a fracture. Test should be repeated several times up and down the shafts of both bones.
Heel Tap Test	Foot is relaxed and in a neutral position	Tibia & Fibula	The foot is held relaxed by one hand in a somewhat neutral position, while the heel of the other hand is used to tap or lightly hit the bottom of the heel from an inferior to superior direction. Pain along the lower leg may indicate a fracture of the tibia or fibula.

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