Orthopedic Exam / Special Tests for Physical Therapy: Ankle and Foot
Talar Tilt Special Test
- supine or sidelying
- The Talar Tilt Test is used to examine the integrity of the calcaneofibular /deltoid ligament and Anterior Talofibular ligament.
Video Instructions, Procedure, Positive Test:
Talar Tilt Special Test:Video Instructions (Procedure below)
Talar Tilt Special Test: PROCEDURE 1:
- the patient lies in the supine or side lying position with the foot relaxed.
- the foot is held in the anatomic (90°) position, which brings the calcaneofibular ligament perpendicular to the long axis of the talus.
- talus is then tilted from side to side into adduction and abduction
- The laxity is compared to the contralateral side.
Talar TILT Special Test: POSITIVE TEST 1:
- Excessive movement on adduction
Talar Tilt Special Test: PROCEDURE 2:
- the patient is seated confortably on the end of an exam table.
- the examiner grasps the foot and places it in anatomical position while stabilizing the tibia and fibula.
- to test the calcaneofibular ligament the examiner will adduct and invert the calcaneous into a varus position.
- the deltoid ligament is examined by abducting and everting the calcaneous into a valgus position.
Talar TILT Special Test: POSITIVE TEST 2:
- A positive test will result in laxity and/or pain
Sensitivity 67, Specificity 75, LR+ 2.7, LR- 0.44.
In a prospective study of 244 patients with ankle lesions a comparison between the talar tilt and the anterior drawer sign was made, leading to the following conclusions: Ligament lesions which are not disclosed by the talar tilt examination may be diagnosed by the anterior drawer sign. The anterior drawer sign cannot replace the talar tilt examination, or vice versa. The two methods are complementary. It is not possible to differentiate between an isolated lesion of the anterior talofibular ligament and a combined lesion of the anterior talofibular and the calcaneofibular ligaments by the two methods.
sources: Orthopedic Physical Examination Tests: An Evidence-Based Approach: “Medial Talar Tilt Stress Test”: Hertel et al., Johannsen, A. 1978. Acta Orthopaedica. Radiological diagnosis of lateral ligament lesion of the ankle: a comparison between talar tilt and anterior drawer sign.