Purpose: ATF ligament sprain or complete tear
How to Perform: Patient lies supine with knee in 90 degrees hanging off the table with foot relaxed. One hand stabilizes the tibia and fibula. The other hand cups the calcaneus of the relaxed foot and pulls the calcaneus anteriorly.
(+): Recreation of pain, increased laxity or movement when test is completed, and/or dimple appears over ATF ligament area = Indicates ATF ligament partial or complete tear and/or ligamentous instability to the CF ligament as well
(-): No recreation of pain, increased laxity or movement when test is completed, and/or dimple appears over ATF ligament area = Indicates no ATF ligament partial or complete tear and/or ligamentous instability to the CF ligament
Purpose: PTF ligament sprain or complete tear
How to Perform: Patient lies supine with knee in 90 degrees hanging off the table with foot relaxed. One hand stabilizes the tibia and fibula. The other hand cups the calcaneus of the relaxed foot and pushes the calcaneus posteriorly.
(+): recreation of pain, excessive anterior mvt, and/or sucking in of skin on both sides of ankle by the Achilles tendon. = Indicates ligamentous instability of PTF, CF, and/or ATF ligament. Or PTF partial or complete tear.
(-): No Recreation of pain, excessive anterior mvt, and/or sucking in of skin on both sides of ankle by the Achilles tendon = Indicates no ligamentous instability of PTF, CF, and/or ATF ligament. Or PTF partial or complete tear.
Purpose: CF ligament sprain or complete tear
How to Perform: Patient’s leg hanging off the table, foot in neutral (90 degree) position). Cup the calcaneus and invert the foot.
(+): Recreation of pain or increased laxity of the CF ligament = Indicates partial or complete tear of CF ligament
(-): No recreation of pain or increased laxity of the CF ligament = Indicates no partial or complete tear of CF ligament
Purpose: PTF ligament sprain or complete tear
How to Perform: Test bilaterally, Patient’s leg hanging off the table, foot in dorsiflexion. Cup the calcaneus and invert the foot.
(+): Recreation of pain or increased laxity of PTF ligament = Indicates partial or complete tear of PTF ligament
(-): No recreation of pain or increased laxity of PTF ligament = Indicates no partial or complete tear of PTF ligament
Purpose: ATF ligament sprain or complete tear
How to Perform: Patient’s leg hanging off the table, foot in plantar flexion. Cup the calcaneus and invert the foot.
(+): Recreation of pain or increased laxity of the ATF ligament = Indicates partial or complete tear of ATF ligament
(-): No recreation of pain or increased laxity of the ATF ligament = Indicates no partial or complete tear of ATF ligament
Purpose: Bifurcate ligament sprain or complete tear
How to Perform: Test bilaterally. Patient’s leg hanging off the table, foot in neutral (90 degree) position). Cup the calcaneus and have the other hand hold the forefoot while inverting the foot.
(+): Recreation of pain or increased laxity of bifurcate ligament = Indicates partial or complete tear of bifurcate ligament
(-): No recreation of pain or increased laxity of bifurcate ligament = Indicates no partial or complete tear of bifurcate ligament
Purpose: deltoid ligament sprain or complete tear
How to Perform: Test bilaterally. Patient’s leg hanging off the table, foot in neutral (90 degree) position). Cup the calcaneus and evert the foot.
(+): Recreation of pain or increased laxity in the deltoid ligaments = Indicates partial or complete tear of deltoid ligament
(-): No recreation of pain or increased laxity in the deltoid ligaments = Indicates no partial or complete tear of deltoid ligament
Purpose: Spring ligament sprain or complete tear
How to Perform: Test bilaterally. Patient’s leg hanging off the table, foot in dorsiflexion. Cup the calcaneus and with the other hand hold the forefoot while everting the foot.
(+): Recreation of pain or increased laxity in the spring ligament = Indicates spring ligament partial or complete tear
(-): No recreation of pain or increased laxity in the spring ligament = Indicates no spring ligament partial or complete tear
Purpose: Syndesmosis sprain (high ankle sprain or injury)
How to Perform: Patient is asked to move ankle into extreme dorsiflexion such as squatting. Patient performs squat. Then you would apply a compression forces surrounding both malleoli, then have patient squat again while compression force is applied.
(+): Patient feels a relief of pain as compression along both malleoli is applied with movement being performed or patient has and increased dorsiflexion range = Indicates syndesmosis sprain/injury
(-): Patient doesn’t feel a relief of pain as compression along both malleoli is applied with movement being performed or patient has and increased dorsiflexion range = Indicates no syndesmosis sprain/injury
Purpose: syndesmosis sprain (high ankle sprain)/translation of fibula of distally/syndesmosis
How to Perform: Patient’s leg is hanging off the edge of the table with leg completely relaxed. Then one will move the distal portion of the fibula anteriorly and posteriorly.
(+): Recreation of pain and/or increased movement as the distal fibula is translated ant and posterior = Indicates syndesmosis sprain/injury
(-): No recreation of pain and/or increased movement as the distal fibula is translated ant and posterior = Indicates no syndesmosis sprain/injury
Purpose: syndesmosis (high ankle sprain) or syndesmosis injury
How to Perform: Patient sits in chair. Crosses injured leg over uninjured leg. The mid calf of the injured leg should lay on top of the uninjured leg. A gentle force to the medial knee is applied.
(+): Recreation of pain felt in distal syndesmosis and/or a stretch is felt in the AITF ligament = Indicates syndesmosis sprain/injury
(-): No recreation of pain felt in distal syndesmosis and/or a stretch is felt in the AITF ligament = Indicates no syndesmosis sprain/injury
Purpose: syndesmosis sprain or injury
How to Perform: Patient sits at end of table, one hand stabilizes the leg while the other cups the calcaneus using their forearm to forcefully dorsiflexes the foot.
(+): Recreation of pain as foot is placed into forced dorsiflexion = Indicates syndesmosis sprain/injury
(-): No recreation of pain is felt as foot is placed into forced dorsiflexion = Indicates no syndesmosis sprain/injury
Purpose: fx
How to Perform: Pt's leg is hanging off the table. Starting at proximal tib/fib joint compression both sides of lower leg working down to the ankle
(+): Recreation of pain and/or point tenderness any time along the tibia and fibula while squeezing them together and working down toward the malleoli = Indicates fracture at site of pain
(-): No recreation of pain and/or point tenderness any time along the tibia and fibula while squeezing them together and working down toward the malleoli = Indicates no fracture
Purpose: fx
How to Perform: Patient is sitting with leg off the table. Stabilize leg with one hand. Then apply a firm bump on the heel using your fist
(+): Recreation of pain is felt along shaft of tibia or area of ankle when bump to the heel is applied = Indicates fracture at site of pain
(-): No recreation of pain is felt along shaft of tibia or area of ankle when bump to the heel is applied = Indicates no fracture
Purpose: fx
How to Perform: Patient supine with only ankle hanging off table. Using table as fulcrum, one hand is slightly above the malleoli while the other hand is on top the navicular/cuboid area. Both sides then have a downward force to the bone trying to “break” the bone.
(+): Recreation of pain is felt as force is applied to “break” the bone = Indicates fracture at site of pain
(-): No recreation of pain is felt as force is applied to “break” the bone = Indicates no fracture
Purpose: Achilles tendon rupture
How to Perform: Patient is prone on table with foot handing off the side. Belly of the calf muscle is squeezed looking to see if there is a reaction of plantar flexion by tested foot.
(+): Absence of reaction of planter flexion when calf belly muscle is squeezed = Indicates possible achilles tendon rupture
(-): Foot plantar flexions when calf belly muscle is squeezed = Indicates achilles tendon is still in tact
Purpose: tarsal tunnel syndrome
How to Perform:
Patient’s foot is relaxed on the table. One finger taps the posterior tibial nerve behind the medial malleolus or the anterior tibial branch of the deep perineal nerve at the front of the ankle.
(+): Recreation of tingling or paresthesia felt being felt distally = Indicates tarsal tunnel syndrome
(-): No recreation of tingling or paresthesia felt distally by patient = Indicates no tarsal tunnel syndrome
Purpose: to determine if there is need for radiographs
An ankle
Purpose: Syndesmosis sprain (high ankle sprain or injury)
How to Perform: Patient’s leg hanging off the table, foot in neutral (90 degrees). One hand is stabilizing the tibia and fibula. Cupping the heel a force is applied to the talus forcing it into the tibiotalar joint while the foot is being put into passive lateral and medial rotation.
(+): Recreation of pain produced over the anterior or posterior tibiofibular ligaments and interosseous membrane area = Indicates syndesmosis sprain/injury
(-): No recreation of pain produced over the anterior or posterior tibiofibular ligaments and interosseous membrane area = Indicates no syndesmosis sprain/injury
Purpose: tendon subluxation of the peroneus longus and brevis
How to Perform: Patient is supine on table and is asked to dorsiflexion and evert the foot. One hand places the thumb and index finger on both sides of ankle. And this acts as the peroneal retinaculum for the foot as the patient try to dorsiflexion and everting their foot.
(+): Patient feels a relief of pain as they are performing dorsiflexion with eversion of the foot as compression is applied = Indicates subluxation of peroneal tendons of peroneous longs and brevis
(-): Patient doesn’t feel a relief of pain when performing motion of test with compression = No subluxation of peroneal longus and brevis tendons