The Ankle and Foot Exam Basics

Anterior Drawer

  • Passive

  • Tests Anterior Talo-Fibular Ligament

  • Technique

    • Patient seated with lower leg relaxed and hanging off table

    • Examiner in front of patient

    • Examiner grasps the lower leg above the ankle with one hand and the heel/hindfoot with the other

    • While stabilizing the tibia the foot is pulled anteriorly

    • A positive result occurs when there is excessive anterior translation and/or pain, especially when compared with the unaffected side

    • A negative result is when there is no increased translation or pain with the maneuver

Posterior Drawer

  • Passive

  • Tests Posterior Talo-Fibular Ligament

  • Technique

    • Patient seated with lower leg relaxed and hanging off table

    • Examiner in front of patient

    • Examiner grasps the lower leg above the ankle with one hand and the dorsal mid foot with the other

    • While stabilizing the tibia the foot is pushed posteriorly

    • A positive result occurs when there is excessive posterior translation and/or pain, especially when compared with the unaffected side

    • A negative result is when there is no increased translation or pain with the maneuver

Talar Tilt

  • Passive

  • Tests Calcaneo-Fibular Ligament

  • Technique

    • Patient seated with lower leg relaxed and hanging off table

    • Examiner in front of patient

    • Examiner grasps the lower leg above the ankle with one hand and the heel/hindfoot with the other

    • While stabilizing the tibia the foot is inverted

    • A positive result occurs when there is excessive inversion of the hindfoot and/or pain, especially when compared with the unaffected side

    • A negative result is when there is no increased inversion laxity or pain with the maneuver

Kleiger Maneuver

  • Passive

  • Tests Tibia-fibular Ligaments and syndesmosis

  • Technique

    • Patient seated with lower leg relaxed and hanging off table

    • Examiner in front of patient

    • Examiner grasps the lower leg with one hand and the mid and forefoot with the other

    • While stabilizing the tibia the foot is externally rotated

    • A positive result occurs when there is external rotation/tibio-fibular widening and/or pain, especially when compared with the unaffected side

    • A negative result is when there is no increased laxity or pain with the maneuver

Squeeze Test

  • Passive

  • Tests Tibia-Fibular Ligaments and syndesmosis

  • Technique

    • Patient seated with lower leg relaxed and hanging off table

    • Examiner in front of patient

    • Examiner firmly squeezes the proximal portion of the lower leg with both hands "squeezing" the fibula and tibia together

    • A positive result occurs when the maneuver elicits pain distally

    • A negative result is when there is no pain with the maneuver

Thompson Test

  • Passive

  • Tests Achilles tendon integrity

  • Technique

    • Patient prone with the knee flexed to 90°

    • Examiner on the patient's affected side

    • Examiner grasps and squeezes the calf

    • A positive result occurs when the foot does not plantarflex when the calf is squeezed

    • A negative result is when the foot plantarflexes symmetric to the opposite extremity