Special Tests For Conditions of the Ankle and Lower Leg

Special orthopedic tests for the ankle and foot:

Achilles Pinch Test

Assesses for: Achilles Tendon Rupture

Patient Position: The client lies prone with ankle and foot hanging off the table

Therapist Actions: Grasp Achilles tendon between thumb and fingers and squeeze

Positive Sign: Lack of plantarflexion and pain

Ankle Drawer Test

Assesses for: the integrity of the anterior talofibular ligament

Patient Position: Client lies supine. Lower leg can rest on a bolster to take tension off Achilles tendon, or have the knee flexed to 90 degrees

Therapist Actions: stabilize the distal tibia with one hand while holding the foot in 20 degrees of plantarflexion and draw the talus forward (not down) like sliding out a drawer

Positive Sign: a dimple appears in the area of the anterior talofibular ligament if pain or muscle spasm are minimal.

Dorsiflexion-Eversion Test

Assesses for: Tarsal Tunnel Syndrome

Patient Position: Client is supine

Therapist Actions: passively move the ankle into maximum dorsiflexion and eversion while simultaneously holding toes in hyperextension and hold the position for 5-10 seconds

Positive Sign: reproductions of symptoms; a sharp shooting pain around medial ankle and in the plantar surface of the foot

Homan's Sign

Assesses for: Deep vein thrombosis

Patient Position: Client is supine with legs extended

Therapist Actions: passively dorsiflex the foot to lengthen calf muscles

Positive Sign: pain deep to the calf as well as heat and tenderness. leg may be swollen and pallor in color

Morton's Test

Assesses for: Morton's Neuroma

Patient Position: Client supine or seated

Therapist Actions: grasp both sides of the client's foot at the metatarsal heads and apply pressure, squeezing them together

Positive Sign: sharp, shooting pain into the toes

Squeeze Test

Assesses for: syndesmosis (high ankle) sprain

Patient Position: client seated

Therapist Actions: grasp the mid-calf with two hands, one on each side. apply pressure to squeeze the tibia and fibula together, moving distally toward the ankle

Positive Sign: pain in the distal talofibular joint

Talar Tilt Test

Assesses for: integrity of the calcaneofibular ligament

Patient Position: client lies supine or side-lying with knee flexed to take tension out of achilles tendon (leg can be bolstered just above the ankle with a towel). Foot and ankle are in a neutral 90-degree angle

Therapist Actions: grasp the ankle so both thumbs are on the talus on each side of the lateral malleolus. Passively move the foot into inversion.

Positive Sign: pain and mobility (when the foot is in neutral it should resist inversion)

Thompson Test

Assesses for: Achilles Tendon Rupture

Patient Position: client lies prone with ankle and foot off the edge of the table

Therapist Actions: wrap hands around the full bellies of the gastrocnemius and squeeze

Positive Sign: lack of plantarflexion in the ankle

Tibialis Posterior Compression Test

Assesses for: medial tibial stress syndrome (shin splints)

Patient Position: client lies supine with hip and knee flexed so the foot can rest flat on the table

Therapist Actions: grasp the lower mid leg with both hands and apply pressure to the soft tissues along the medial posterior border of the tibia

Positive Sign: reproduction of pain

Windlass Test

Assesses for: Plantar Fasciitis

Patient Position: Client is in a standing position

Therapist Actions: passively extend the big toe. Alternatively, the client can come up onto the balls of the feet one foot at a time

Positive Sign: pain / increased pain at the insertion of the plantar fascia. Lack of extension in the big toe may indicate hallux rigidus

For the next set of questions, answer with the actions the therapist would take. (If you can't remember the name of the test, at least you know what to do!)