Orthopedic Exam / Special Tests for Physical Therapy: Ankle and Foot
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.
Special Test: Posterior Drawer Test ( Ankle)
•Posterior Talofibular ligament injury and/or ligamentous instability
Video Demo Instructions, Procedure, Positive Test:
Special Test: Posterior Drawer Test (Ankle) Video Demo (Procedure below)
Special Test:Posterior Drawer Test (Ankle) PROCEDURE:
•Patient is supine with foot relaxed
•Examiner stabilizes tibia and fibula with one hand
•With the Patient’s foot plantar flexed to 20 degrees, the Examiner holds the patient’s calcaneus with other hand then distracts the calcaneus from the tibia and fibula ( by slowly pulling the calcanues inferiorly)
•Therapist places an posteriorly directed pressure on the calcaneus and talus, applying overpressure at the end of the passive range
Special Test:Posterior Drawer Test (Ankle): POSITIVE SIGN
- Ligamentous laxity or rupture with Presence of sulcus and pain, and/ or
- Excessive posterior translation of the talus.
EVIDENCE/ SENSITIVITY / SPECIFITY:
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.
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).