Functional Assessments at the Ankle Joint

Stork Test – Single Leg Stance Test

- This tests for ankle, knee and sacroiliac stability
- Ask the patient to look straight ahead with their arms by one side, and
to stand on one leg
- Do not specify which leg they must stand on, and do not tell them how
high to lift up the other leg that is off the ground
- Are the toes of the stance leg gripping or changing to white colour?
- Is the foot searching for stability by moving out of inversion and
eversion?
- Observe to see if there is the Trendelenberg sign for the stance leg (hip
drop)
- Is the patella in line with the dorsum of the foot?
- Are the knees caving in?
- Is there tibial torsion?
To increase the difficulty of these tests, you can ask the patient to perform the
test again with their eyes closed; standing on a foam pad or cushion; or by
raising the heel of the foot in the stance position. Remember to assess the
other ankle!

Hop Test
- This test looks for strength deficits in the gastrocnemius and/or the
soleus, and also for weakness in the Achilles
- This test can determine balance differences between the left and right
limbs
- Look for how the client lands on their foot as they land e.g. are the
going in to a flatfoot position? Do they land on their toes and then
distribute more weight towards the back of their foot? Can they stick
the landing for 2 seconds?
- Look to see the movements that occur at the knee joint as well. Are
they going into a valgus knee position, which is causing them difficulty
to land and stick the position?
- Compare the distance jumped between either limbs
- Multiple test variations are useful e.g. single leg hop for distance, single
leg 6m timed hop and the triple hop for distance.

Calf Raise Test

- This test looks for strength deficits in the gastrocnemius and soleus, as
well as the Achilles
- This test is great for determining if there are changes in alignment of
the ankle when the foot goes into plantarflexion e.g. does the person
become flat footed when full contact of the base of the foot makes
contact with the ground? Does it look like more pressure is being
placed on the lateral digits or the hallux during repetitions?
- This test can also determine if there are differences in the range of
weight bearing plantarflexion between ankles
- Again, be sure to test both ankles to determine differences in ankle
alignment and in calf strength by number of performed repetitions.
BESS (Balance Error Scoring System)
- This test is good to assess balance, postural stability, particularly ankle
stability, can possible suggest weakness in the core muscles, and can
be used as a baseline test for return-to-play.
- The Balance Error Scoring System (BESS) consists of 3 stances:
double-leg stance (hands on the hips and feet together), single-leg
stance (standing on the non-dominant leg with hands on hips), and a
tandem stance (non-dominant foot behind the dominant foot) in a heel-
to-toe fashion. The stances are performed on a firm surface and on a
foam surface with the eyes closed, with errors counted during each
20-second trial. An error is defined as opening eyes, lifting hands off
hips, stepping, stumbling or falling out of position, lifting forefoot or
heel, abducting the hip by more than 30°, or failing to return to the test
position in more than 5 seconds

Star Excursion Balance Test (SEBT)

- This test is used to assess dynamic balance, particularly at the ankle
joint, as well as proprioception.
- The goal of the SEBT is to maintain a single leg stance while reaching
out as far as possible with the contralateral leg.
- The patient is to be instructed to reach out as far as possible in all 8
directions by quickly tapping the marked taped with the contralateral
leg. Hands are to be placed on the hips throughout the duration of the
test.
- If the person is standing on their left leg, the right leg moves in the
clockwise direction, and if they are standing on the right leg, their left
leg is to make the touches while moving in an anti-clockwise direction
- Clinical indications: if the person shows a significant decrease in the
reach of one limb in a particular direction when compared to the other
side, this is indicative of loss of dynamic postural control.
- The second-last point that is to be touched requires the client to place
the contralateral leg in front of the stance leg.
- Anterior, posteromedial and posterolateral directions are particularly
indicative of chronic ankle instability
- Failed attempts include not being able to touch the toe on the point on
the floor before returning to the starting position; movement of hands
off the hips prior to completion of the test; any loss of balance resulting
in a heavy toe or foot contact with the floor should be regarded as a
failed attempt.
Knee to Wall Test
- Patient stands facing a wall, with one foot 10cm away from the wall. Be
sure to take into account wall skirting!
- The other leg is placed behind the testing leg around one foot’s
distance
- Patient is instructed to bend at the knee of the foot 10cm from the wall,
in attempt to try and touch the wall with their knee. The heel of the
tested foot must remain on the ground!
- If the knee can touch the wall without the heel of the tested foot lifting
off the ground, the foot is moved back a further 1cm and the test is
repeated. Keep increasing the distance the foot is from the wall until
 the patient cannot touch the wall anymore without the heel raising off
the floor, and make a note of the score.
- The minimum score is 10cm.
- Do the opposite if the knee cannot touch the wall at a 10cm distance
i.e. reduce the distance of the foot from the wall by 1cm, and repeat the
test. Make a note of the measurement at which the client can touch the
wall with their knee.
- TEST THE OPPOSITE SIDE!