Ankle & Foot Special Tests

01. Anterior Drawer Test (Ankle)

02. Babinski’s Test

03. Deltoid Ligamentous Stress Test (Passive Relaxed)

04. Functional Leg Length

05. Functional or Structural Pes Planus Test

06. Homan’s Sign

07. Morton’s Neuroma

08. Posterior Drawer Test (Ankle)

09. Ramirez’s Test

10. Thompson’s Test (Achilles Tendon rupture)

11. Tine’s Sign (Ankle)

01. Anterior Drawer Test(Ankle)

Purpose / Testing for:

Anterior Talofibular Ligament injury and/ or ligamentous instability

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 anteriorly directed pressure on the calcaneus and talus, applying
overpressure at the end of the passive range ( stressing the Anterior Talofibular
ligament)

Positive Sign:

Ligamentous laxity or rupture with Presence of sulcus and pain, and/ or Excessive anterior
translation of the talus, sometimes accompanied by audible sound.
02. Babinski’s Test

Purpose / Testing for:

Spasticity present with Central Nervous System Lesions:

Procedure:

• Patient is supine
• Therapist runs a pointed object along the plantar aspect of the patient’s foot.

Positive Sign:

Positive for CNS lesion = Extension of the big toe and abduction of the other toes. (Babinski
Tests positive for infants up to a few weeks old and is negative after 5– 7 months.).

03. Deltoid Ligamentous Stress Test (Passive Relaxed)

Purpose / Testing for:

To assess the deltoid ligament using 3 separate passive movements:

Procedure:

• Patient is seated with their leg flexed at the knee and hanging over a table.
• Therapist stabilizes the anterior surface of the tibia and fibula proximal to the ankle ( with
one hand)

• To Assess Anterior Fibers of the Deltoid Ligament:

Therapist uses their other hand to graps the dorsal surface of the foot, combining
eversion and plantarflexion of the foot and applying overpressure.

• To Assess Middle Fibers of the Deltoid Ligament:

Therapist repositions their hand so the calcaneus is grasped ( still stabilizing the
anterior surface of the tibia and fibula proximal to the ankle with their other hand).
Hindfoot is taken into eversion with overpressure.

• To Assess Posterior Fibers of the Deltoid Ligament:

Therapist repositions their hand so the calcaneus is grasped ( still stabilizing the
anterior surface of the tibia and fibula proximal to the ankle with their other hand).
Therapist combines eversion and dorsiflexion of the foot with overpressure

Note: to perform a general assessment of the deltoid ligament, evert the hindfoot only
Positive Sign:

• Pain and Hypermobility local to the ligament.

• Muscle spasm end feel may be present with a sub-acute injury.

04. Functional Leg Length

Purpose / Testing for:

Functional Leg length difference resulting from hip, knee or ankle and foot problems

Procedure:
• Patient stands in normal relaxed stance.

• Examiner palpates ASIS and PSIS and notes any differences

• Examiner then positions the patient so that subtalar joints are neutral, toes pointed forward
and the knees are straight.

• Examiner re-evaluates ASIS and PSIS

Positive Sign:

Difference in leg length disappear

.05. Functional or Structural Pes Planus Test

Brief abut Pes Planus

Pes planus also known as flat foot is the loss of the medial longitudinal arch of the foot,
heel valgus deformity, and medial talar prominence. In lay terms, it is a fallen arch of the
foot that caused the whole foot to make contact with the surface the individual is standing
on. The deformity is usually asymptomatic and resolves spontaneously in the first decade
of life, or occasionally progresses into a painful rigid form which causes significant
disability. All at birth has flat feet and noticeable foot arch are seen at around the age of
3years.

It is of two forms; flexible flat foot and rigid flat foot. When the arch of the foot is intact on
heel elevation and non-bearing but disappears on full standing on the foot, it is termed
flexible flat foot while rigid flat foot is when the arch is not present in both heel elevation
and weight bearing

Purpose / Testing for:

To determine whether a pes planus is functional or structural

Procedure:
Therapist observes (and compares) the orientation of the client’s medial longitudinal arch
while doing each of the following:
• Patient stands straight with both heels and toes on the ground
• Patient stands with just the toes on the ground
• Patient sits on the table

Positive Sign:

• Functional Pes Planus = if medial longitudinal arch is restored when the client is either
standing on the toes or seated = due to muscle or ligament weakness

• Structural Pes Planus = if medial longitudinal arch remains flat when the client is standing
on toes and when seated.

06. Homan’s Sign

Purpose / Testing for:

Deep Vein Thrompophlebitis / Deep Vein Thrombosis

Procedure:
• Patient supine with the knee extended**

• Patient’s foot is passively dorsi flexed**

.Positive sign:

Pain deep in the calf during dorsi flexion

also:

• tenderness elicited on palpation of the calf

• pallor and swelling in leg,
• loss of dorsalis pedis pulse

** massage is contraindicated with a positive test; refer patient

Morton’s Neuroma (is a benign neuroma of an

07. Morton’s Neuroma
intermetatarsal plantar nerve, most commonly of the
Purpose / Testing for:
second and third intermetatarsal spaces (between 2nd-
The presence of Morton’s Neuroma 3rd and 3rd-4th metatarsal heads). This problem is

Procedure: characterised by pain and/or numbness, sometimes

relieved by removing footwear.
• Patient is seated
• Compress the foot by applying pressure to the medial and lateral aspects of the foot at the
metatarsophalangel joints
Positive Sign:
Sharp pain at the location of the neuroma. Pain is worsend by activity.
08. Posterior Drawer Test (Ankle)
Purpose / Testing for:
Posterior Talofibular ligament injury and/or ligamentous instability

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.

Positive sign:
Ligamentous laxity or rupture with Presence of sulcus and pain, and/ or Excessive posterior
translation of the talus.

09. Ramirez’s Test

Purpose / Testing for:

Deep Vein Thrombosis.

Procedure:

• Patient is supine, affected Knee in flexion ( foot flat on the table).

• Wrap a blood pressure cuff around the thigh and inflate it to 40mm Hg.
• Maintain the pressure for at least 2 minutes.

Positive Sign:

Increase in pain as the cuff is inflated and inability to tolerate cuff inflation and sustained
pressure for 2 minutes.

10. Thompson’s Test (Achilles Tendon rupture)

Purpose / Testing for:

3rd degree strain or rupture of the Achilles tendon

Procedure:

• Patient is prone , feet over the edge of the table, legs relaxed
• Squeeze the affected gastrocnemius and soleus muscles.
Positive Sign:

Absence of plantar-flexion when the muscles are squeezed

11. Tine’s Sign (Ankle)

Purpose / Testing for:

Anterior or Posterior Tibial Nerve entrapment or dysfunction

Procedure:
• Anterior tibial branch of deep peroneal nerve is tapped in front of the ankle
• The Posterior tibial nerve tapped as it passes behind the medial malleolus

Positive Sign:

Tingling or Paresthesia felt distally.