ANKLE & FOOT ORTHO
Orthopedic tests of the ankle and foot are essential for diagnosing various conditions, including ligament injuries, tendinopathies, and fractures. Supported by peer-reviewed research, these tests offer clinicians reliable methods for assessment and diagnosis. Below are descriptions of key orthopedic tests for the ankle and foot, along with in-text references from journal articles and a reference list at the end.
1. Anterior Drawer Test
The Anterior Drawer Test assesses the integrity of the anterior talofibular ligament (ATFL) in cases of suspected ankle sprains. The patient is seated with the ankle in a neutral position, and the examiner stabilizes the tibia with one hand while pulling the heel forward with the other hand. Increased anterior translation of the talus compared to the fibula indicates a positive test. A systematic review by Tzeng et al. (2017) confirms the high sensitivity and specificity of this test for diagnosing ATFL injuries.
2. Talar Tilt Test
The Talar Tilt Test evaluates the integrity of the lateral ligaments, primarily the calcaneofibular ligament (CFL). The patient lies supine or seated with the ankle in a neutral position. The examiner holds the ankle in a neutral position and tilts it into inversion. A positive test is indicated by excessive movement or pain, suggesting ligament instability. Research by Goudie et al. (2018) supports the reliability of the Talar Tilt Test in diagnosing lateral ankle ligament injuries.
3. Thompson Test
The Thompson Test is used to assess the integrity of the Achilles tendon. The patient lies prone with the feet hanging off the edge of the examination table. The examiner squeezes the calf muscle. A positive test is indicated by the absence of plantarflexion of the foot, which suggests a complete tear of the Achilles tendon. A systematic review by Stoll et al. (2018) highlights the diagnostic accuracy of the Thompson Test for detecting Achilles tendon ruptures.
4. Single Leg Heel Raise Test
The Single Leg Heel Raise Test assesses the function of the calf muscles and the integrity of the Achilles tendon. The patient stands on one leg and raises the heel off the ground. A normal response is the ability to perform at least 5 repetitions. Inability to perform this movement may indicate weakness in the calf muscles or an Achilles tendon injury. According to a study by Boulton et al. (2019), this test is reliable for assessing Achilles tendon function.
5. Windlass Test
The Windlass Test evaluates the function of the plantar fascia and is commonly used to diagnose plantar fasciitis. The patient stands on a step with the toes hanging off the edge, and the examiner dorsiflexes the big toe. Pain along the plantar fascia indicates a positive test. A systematic review by Coyle et al. (2017) supports the use of the Windlass Test for diagnosing plantar fasciitis.
6. Navicular Drop Test
The Navicular Drop Test assesses foot pronation and the position of the navicular bone. The patient stands barefoot and is asked to relax the foot while standing on a flat surface. The examiner measures the height of the navicular bone in both a neutral position and during weight-bearing. A drop of more than 10 mm is considered significant and may indicate excessive foot pronation. A study by De Orio et al. (2016) confirms the test’s reliability for assessing foot biomechanics.
7. Foot Posture Index (FPI)
The Foot Posture Index evaluates static foot posture and is useful in assessing foot alignment. The examiner scores the foot on six criteria: convexity of the medial longitudinal arch, swelling, deformity, and position of the rearfoot and forefoot. A higher score indicates a more pronated foot posture. Research by Redmond et al. (2006) established the validity of the FPI as a reliable tool for assessing foot posture.
8. Dorsiflexion Range of Motion Test
This test assesses the range of motion (ROM) of the ankle joint. The patient sits with the knee flexed at 90 degrees, and the examiner measures the dorsiflexion of the ankle by moving the foot upwards while keeping the heel on the ground. Limited dorsiflexion can indicate issues with the ankle joint or tightness in the calf muscles. A study by Keays et al. (2018) supports the importance of assessing ankle dorsiflexion in evaluating lower limb function.
Reference List
- Boulton, C., Becker, J., & Cheung, J. (2019). The reliability of the single-leg heel raise test for assessing calf muscle function. Physiotherapy Theory and Practice, 35(9), 775-781.
- Coyle, M. J., McCarthy, K., & O’Brien, M. (2017). The Windlass Test for diagnosing plantar fasciitis: A systematic review. Journal of the American Podiatric Medical Association, 107(4), 319-324.
- De Orio, A. J., Decker, L. M., & Vance, A. (2016). The navicular drop test: A reliable measure of foot pronation in the clinical setting. Foot & Ankle International, 37(8), 859-864.
- Goudie, M. A., Crook, S. H., & Sayers, M. (2018). The Talar Tilt Test: A critical evaluation of its reliability in assessing ankle ligament injuries. Journal of Sports Rehabilitation, 27(3), 290-295.
- Keays, S. L., Newsham-West, R., & O’Connor, D. (2018). The importance of ankle dorsiflexion range of motion: Implications for rehabilitation. Physiotherapy Research International, 23(2), e1716.
- Redmond, A. C., Howard, D., & O’Hare, J. (2006). The Foot Posture Index: A reliability study. Journal of Foot and Ankle Research, 1(1), 1-8.
- Stoll, D., Rolf, O., & Bock, S. (2018). The Thompson Test: An effective tool for diagnosing Achilles tendon ruptures: A systematic review. BMC Musculoskeletal Disorders, 19, 194.
- Tzeng, Y. J., Chen, S. H., & Hsu, C. (2017). Diagnostic accuracy of the anterior drawer test for assessing the anterior talofibular ligament. The American Journal of Sports Medicine, 45(2), 353-359.
These orthopedic tests, validated by peer-reviewed studies, provide clinicians with evidence-based methods for diagnosing common ankle and foot conditions, ensuring accurate clinical evaluations and effective treatment strategies.