Manual Muscle Testing of the Ankle

Motion	Patient Position	Start Position	End Position
Plantarflexion (Gastrocnemius and Soleus in standing position)	Patient stands on test limb with knee extended. Patient may place one or two fingers on a table or other external surface to assist with balance. Therapist should stand or sit with a lateral view of test limb. Patient actively raises heel from floor 20 consecutive times without rest or fatigue through a full range of plantarflexion.
Plantarflexion (Soleus only in standing position)	Patient stands on test limb with knee slightly flexed. One or two fingers may be used to assist with balance. Therapist stands or sits with a lateral view of test limb. Patient actively raises heel from floor 20 consecutive times without rest or great fatigue through full range of plantarflexion.
Neutral Dorsiflexion (Tibialis Anterior, Extensor Digitorum Longus, Peroneus Tertius, Extensor Hallicus Longus)	Patient is short sitting with ankle plantarflexed. Therapist sits on stool in front of patient and uses one hand to stabilize the leg just above the malleoli. The other hand is used for resistance by placing it on the dorsal aspect of the foot. Patient actively dorsiflexes against resistance.
Inversion	The patient is short sitting with ankle in slight plantar flexion. Therapist sits in front or on side of test limb and uses one hand to stabilize the ankle just above the malleoli. The other hand provides resistance by contouring over the dorsum and medial side of the foot at the level of the metatarsal heads. Resistance is directed toward eversion and slight dorsiflexion while patient actively inverts foot.
Inversion with dorsiflexion	Patient may be short sitting or supine. The therapist sits on a stool in front of the patient with patient's heel resting on thigh. One hand stabilizes posterior leg just above the malleoli while other hand provides resistance over the dorsomedial aspect of foot. Patient actively dorsiflexes ankle and inverts foot, keeping toes relaxed.
Eversion	The patient is short sitting with ankle in slight plantar flexion. Therapist sits in front or on side of test limb and uses one hand to stabilize the ankle just above the malleoli. The other hand provides resistance by contouring over the dorsum and medial side of the foot at the level of the metatarsal heads. Resistance is directed toward inversion and slight dorsiflexion while patient actively everts foot.
Eversion with plantar flexion	Patient is short sitting with ankle in neutral position. Therapist is sitting on a stool in front of patient. One hand stabilizes the ankle just above the malleoli while other hand provides resistance around the dorsum and lateral border of the forefoot. Resistance is directed toward inversion and slight dorsiflexion. Patient actively turns the foot down and out.

Adapted from:

Hislop, Helen J. & Montgomery, Jaqueline with contributor Barbara Connelly.

      Daniels and Worthingham's muscle testing: techniques of manual examination., 6th edition, 1995.