Anterior Drawer Test – Ankle

Orthopedic Exam / Special Tests for Physical Therapy: Ankle and Foot

Special Test: Anterior Drawer Test – Ankle (SUPINE)

  • to test for injuries to the anterior talofibular ligament
  • to test for anterior Talofibular Ligament injury and/ or ligamentous instability
  • To test for one-plane anterior instability
The purpose of this test was to determine whether ankle mechanical instability or hypermobility in the sagital plane of the talo-crural joint (or upper ankle joint) is present.

Video Demo, Procedure, Positive Test:

Orthopedic Exam: Anterior Drawer Ankle Video Demo (Procedure below)

Anterior Drawer – Ankle PROCEDURE (supine): 

  • The patient lies supine with the foot relaxed.
  • the examiner stabilizes the tibia and fibula, holds the patient’s foot in 20° of plantar flexion, and draws the talus forward in the ankle mortise

Anterior Drawer Test – (Ankle): POSITIVE TEST:

  • Excessive anterior translation. Sometimes, a dimple appears over the area of the anterior talofibular ligament on anterior translation (dimple or suction sign) if pain and muscle spasm are minimal

Ankle Special Test for Orthopedic Examination:

Special Test: Anterior Drawer Test – Ankle PROCEDURE (prone): 

  • The patient lies prone with the feet extending over the end of the examining table.
  • With one hand, the examiner pushes the heel steadily forward

(Ankle) Anterior Drawer Test: POSITIVE TEST (prone):

  • Excessive anterior movement and a “sucking in” of the skin on both sides of the Achilles tendon.

Evidence, Sensitivity, Specificity:

Anterior drawer has sensitivity of 86 percent and specificity of 74 percent for a diagnostic test of 160 patients with an inversion ankle sprain when compared to an arthrogram. The +LR .22 and -LR .0018 (is this from Van Dijk?). 
In a prospective, blinded, diagnostic-accuracy study Croy et al. measured diagnostic accuracy of the anterior drawer test of the ankle in sixty-six subjects with a history of lateral ankle sprain. Using ultrasound imaging during performance of the the anterior drawer test the talofibular interval was measured digitally.
Sensitivity of the the anterior drawer test was 0.74 (95% confidence interval [CI]: 0.58, 0.86) and 0.83 (95% CI: 0.64, 0.93) at the 2.3 mm or greater and 3.7 mm or greater reference standards, respectively. Specificity of the test was 0.38 (95% CI: 0.24, 0.56) and 0.40 (95% CI: 0.27, 0.56), respectively. Positive likelihood ratios were 1.2 and 1.4, whereas the negative likelihood ratios were 0.66 and 0.41, respectively (Croy et al., 2013)(Evidence level 2B).