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Special Tests for Ankle Joint – A Physiotherapist’s Guide to Accurate Diagnosis.

  • Writer: PHYSIO 360
    PHYSIO 360
  • Apr 10
  • 3 min read

Updated: Apr 12



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INTRODUCTION;

The ankle joint is a complex structure bearing the entire body's weight while allowing for mobility, stability, and shock absorption. Whether it’s a sports injury, chronic instability, or post-traumatic condition, clinical diagnosis of ankle disorders requires not only observation and palpation but also special orthopedic tests that help pinpoint the specific injury.

In this blog, we’ll explore the most commonly used special tests for the ankle joint, categorized by the structures they assess: ligaments, tendons, syndesmosis, and nerve involvement.


Why Special Tests Matter in Ankle Assessment.

Special tests help clinicians:

✅ Detect ligament sprains and ruptures

✅ Identify tendon pathologies (like Achilles tendinopathy)

✅ Confirm syndesmotic (high ankle) sprains

✅ Rule out fractures or nerve entrapments

✅ Plan appropriate physiotherapy or medical intervention


1. Ligamentous Special Tests

Anterior Drawer Test

  • Purpose: To assess the integrity of the anterior talofibular ligament (ATFL)

  • How to Perform: Patient is supine or seated. The therapist stabilizes the tibia and pulls the heel forward.

  • Positive Sign: Excessive anterior translation of the talus = ATFL injury


Talar Tilt Test

  • Purpose: Evaluates the calcaneofibular ligament (CFL) and deltoid ligament

  • How to Perform: With the ankle in neutral, invert the foot to test the CFL and evert to test the deltoid ligament.

  • Positive Sign: Increased motion compared to the opposite side = Ligament laxity or tear


2. Syndesmosis (High Ankle Sprain) Tests

Squeeze Test

  • Purpose: To identify syndesmotic sprain (injury to the ligaments between the tibia and fibula)

  • How to Perform: Squeeze the tibia and fibula together at the mid-calf level

  • Positive Sign: Pain at the distal tibiofibular joint = Positive


External Rotation Test (Kleiger’s Test)

  • Purpose: Evaluates the anterior inferior tibiofibular ligament (AITFL)

  • How to Perform: Stabilize the leg, dorsiflex and externally rotate the foot

  • Positive Sign: Pain over the syndesmosis = Positive for high ankle sprain




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3. Achilles Tendon Special Tests

Thompson Test (Simmonds' Test)

  • Purpose: To test for Achilles tendon rupture

  • How to Perform: The Patient lies prone, and the therapist squeezes the calf

  • Positive Sign: Absence of plantarflexion = Complete Achilles tendon rupture


4. Fracture Screening Test

Ottawa Ankle Rules

  • Purpose: To rule out fractures and decide if X-rays are necessary

  • Positive Criteria:

    • Bone tenderness at the posterior edge of the tibia/fibula or tip of the malleoli

    • Inability to bear weight for 4 steps

  • Use: Helps reduce unnecessary radiographs


5. Nerve Entrapment & Tarsal Tunnel Syndrome Tests

Tinel’s Sign at the Ankle

  • Purpose: Identifies tibial nerve irritation in the tarsal tunnel

  • How to Perform: Tap over the posterior tibial nerve behind the medial malleolus

  • Positive Sign: Tingling or shooting pain in the foot = Positive for tarsal tunnel syndrome


6. Functional & Dynamic Tests

Single Leg Balance Test

  • Purpose: Assess ankle proprioception and stability

  • How to Perform: Patient stands on one leg with eyes open/closed

  • Positive Sign: Poor balance or excessive wobbling = Proprioceptive deficit

Star Excursion Balance Test (SEBT)

  • Purpose: Detect dynamic stability and injury risk

  • How to Perform: Patient stands on one foot and reaches in multiple directions with the other

  • Positive Sign: Asymmetry or poor control = Ankle instability or neuromuscular imbalance



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Clinical Application & Physiotherapy Implications

Special tests guide physiotherapists in creating customized rehab programs for:

  • Lateral ankle sprains (focusing on strengthening ATFL/CFL)

  • Medial ankle instability

  • High ankle sprains (syndesmosis-specific rehab protocols)

  • Achilles tendon injuries (eccentric loading, tendon gliding)

  • Tarsal tunnel syndrome (nerve gliding, decompression)

Each test must be interpreted in the clinical context, considering the patient’s history, symptoms, and other examination findings. False positives and negatives can occur, so combining multiple tests often provides a clearer picture.


Final Thoughts

Ankle joint injuries can be subtle yet debilitating if left undiagnosed or mismanaged. Mastering these special tests ensures accurate assessment, targeted treatment, and faster recovery for patients.

If you're dealing with persistent ankle pain or instability, seek expert help from a physiotherapy clinic or sports rehab center near you.


Looking for expert ankle rehabilitation? Visit Physio360 Chennai – trusted for accurate diagnosis, personalized rehab, and faster recovery from foot and ankle injuries.


REFERENCE AND RESEARCH ARTICLE :

1.Physical Examination of the Ankle: A Review of the Original Orthopedic Special Test Description and Scientific Validity of Common Tests for Ankle Examinationhttps://pmc.ncbi.nlm.nih.gov/articles/PMC7853358/.


2.Physical Examination of the Ankle: A Review of the Original Orthopedic Special Test Description and Scientific Validity of Common Tests for Ankle Examinationhttps://pubmed.ncbi.nlm.nih.gov/33543095/.


 
 
 
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