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Textbook
Introduction
1. Cardiovascular system
2. Pulmonary system
3. Neuromuscular system
4. Pediatrics
5. Musculoskeletal system
5.1 Anatomy of musculoskeletal system
5.2 Anatomical terminology and exercise training principles
5.3 Joint mechanics and phases of healing
5.4 Upper extremity anatomy
5.5 Special tests of upper extremity
5.6 Comparing clinical presentation and interventions for upper extremity
5.7 Lower extremity anatomy
5.8 Special tests of lower extremity
5.8.1 Hip special tests
5.8.2 Knee special tests
5.8.3 Ankle and foot special tests
5.9 Comparing clinical presentation and interventions for lower extremity
5.10 Spine and pelvis anatomy
5.11 Special tests of the spine, pelvis, and temporomandibular joint
5.12 Comparing clinical presentation and interventions for the spine, pelvis, and temporomandibular joint
5.13 Other musculoskeletal conditions
5.14 Gait
5.15 Prosthetics
5.16 Orthotics
5.17 Medications, imaging, and fractures
5.18 Surgical protocols
6. Other systems
7. Non-systems
Wrapping up
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5.8.3 Ankle and foot special tests
Achievable NPTE-PTA
5. Musculoskeletal system
5.8. Special tests of lower extremity
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Ankle and foot special tests

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These special tests check the integrity of the ankle ligaments, the Achilles tendon, and the plantar fascia. As a PTA, you perform them to collect objective data within the plan of care - document any positive finding and report it to the supervising PT.

  • Anterior drawer test
    • Patient supine with foot off the edge of the mat; ankle in 20 degrees of plantarflexion; therapist translates the talus anteriorly while stabilizing the lower leg
      • Tests the integrity of the anterior talofibular ligament
      • Mechanism: used after an inversion ankle sprain, since the ATFL is the most commonly injured ankle ligament
    • Positive: excessive anterior talar translation compared with the uninvolved side, and/or pain
Clinician performing an anterior drawer test on a patient's ankle while stabilizing the lower leg.
Anterior drawer test (ankle)
Achievable
  • Talar tilt
    • Patient sitting with the knee bent and ankle relaxed in neutral (90 degrees), the position that loads the calcaneofibular ligament (an inversion stress in plantarflexion mainly loads the anterior talofibular ligament instead); therapist stabilizes the distal tibia and moves the foot into adduction (calcaneofibular ligament) and abduction (deltoid ligament)
      • Tests the integrity of the calcaneofibular and deltoid ligaments
      • Inversion stresses the calcaneofibular ligament, the typical ankle sprain mechanism; eversion stresses the deltoid ligament, a less common injury
    • Positive: laxity compared with the uninvolved side, and/or pain
Talar tilt test of the ankle using inversion and eversion stress to assess the integrity of the lateral and medial collateral ligaments.
Talar tilt test
Achievable
  • Thompson’s test
    • Patient prone with foot off the edge of the mat; the therapist squeezes the calf muscle; normally the ankle plantarflexes
      • Tests the integrity of the Achilles tendon
      • Mechanism: a sudden push-off or jumping injury with a reported “pop” and difficulty bearing weight
    • Positive: no movement of the foot
      • Red flag: suggests Achilles tendon rupture - stop and report to the supervising PT for prompt physician or orthopedic referral
Therapist squeezing the calf of a prone patient with feet off the edge of the mat to check for reflexive ankle plantarflexion.
Thompson test
Achievable
  • Windlass test
    • Weight bearing: patient stands with toes over the edge of a step while the examiner passively dorsiflexes the first metatarsophalangeal (MTP), or big toe, joint
    • Non-weight bearing: patient seated with knee flexed to 90 degrees while the examiner stabilizes the ankle and passively dorsiflexes the first MTP joint
      • Both positions test for the presence of plantar fasciitis
      • Mechanism: a common cause of first-step morning heel pain
    • Positive: reproduction of heel/plantar fascia pain at end-range great-toe extension
Windlass test with passive dorsiflexion of the great toe to assess plantar fasciitis.
Windlass test
Achievable

The pathophysiology, clinical presentation, and intervention considerations for these lower extremity conditions are covered in the next chapter, Comparing clinical presentation and interventions for lower extremity.

Anterior drawer test

  • Position: supine, foot off mat, ankle 20° plantarflexion; therapist translates talus anteriorly
  • Tests anterior talofibular ligament (ATFL), most commonly injured in inversion sprains
  • Positive: excessive anterior translation vs. uninvolved side and/or pain

Talar tilt test

  • Position: sitting, knee bent, ankle neutral (90°); stabilize distal tibia, move foot into adduction (tests calcaneofibular ligament) and abduction (tests deltoid ligament)
  • Inversion = calcaneofibular ligament (common sprain mechanism); eversion = deltoid ligament (less common)
  • Positive: laxity vs. uninvolved side and/or pain

Thompson’s test

  • Position: prone, foot off mat; squeeze calf muscle, normal response = ankle plantarflexion
  • Tests Achilles tendon integrity; mechanism often sudden push-off/jump with “pop” and weight-bearing difficulty
  • Positive: no foot movement → red flag for Achilles rupture; stop and report to PT for prompt physician/orthopedic referral

Windlass test

  • Weight-bearing: standing, toes over step edge, passively dorsiflex great toe
  • Non-weight-bearing: seated, knee at 90°, stabilize ankle, passively dorsiflex great toe
  • Tests for plantar fasciitis (classic first-step morning heel pain)
  • Positive: reproduction of heel/plantar fascia pain at end-range toe extension

General PTA role

  • These tests gather objective data within plan of care
  • Document positive findings and report to supervising PT
  • Follow-up pathophysiology/intervention details covered in next chapter

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Ankle and foot special tests

These special tests check the integrity of the ankle ligaments, the Achilles tendon, and the plantar fascia. As a PTA, you perform them to collect objective data within the plan of care - document any positive finding and report it to the supervising PT.

  • Anterior drawer test
    • Patient supine with foot off the edge of the mat; ankle in 20 degrees of plantarflexion; therapist translates the talus anteriorly while stabilizing the lower leg
      • Tests the integrity of the anterior talofibular ligament
      • Mechanism: used after an inversion ankle sprain, since the ATFL is the most commonly injured ankle ligament
    • Positive: excessive anterior talar translation compared with the uninvolved side, and/or pain
  • Talar tilt
    • Patient sitting with the knee bent and ankle relaxed in neutral (90 degrees), the position that loads the calcaneofibular ligament (an inversion stress in plantarflexion mainly loads the anterior talofibular ligament instead); therapist stabilizes the distal tibia and moves the foot into adduction (calcaneofibular ligament) and abduction (deltoid ligament)
      • Tests the integrity of the calcaneofibular and deltoid ligaments
      • Inversion stresses the calcaneofibular ligament, the typical ankle sprain mechanism; eversion stresses the deltoid ligament, a less common injury
    • Positive: laxity compared with the uninvolved side, and/or pain
  • Thompson’s test
    • Patient prone with foot off the edge of the mat; the therapist squeezes the calf muscle; normally the ankle plantarflexes
      • Tests the integrity of the Achilles tendon
      • Mechanism: a sudden push-off or jumping injury with a reported “pop” and difficulty bearing weight
    • Positive: no movement of the foot
      • Red flag: suggests Achilles tendon rupture - stop and report to the supervising PT for prompt physician or orthopedic referral
  • Windlass test
    • Weight bearing: patient stands with toes over the edge of a step while the examiner passively dorsiflexes the first metatarsophalangeal (MTP), or big toe, joint
    • Non-weight bearing: patient seated with knee flexed to 90 degrees while the examiner stabilizes the ankle and passively dorsiflexes the first MTP joint
      • Both positions test for the presence of plantar fasciitis
      • Mechanism: a common cause of first-step morning heel pain
    • Positive: reproduction of heel/plantar fascia pain at end-range great-toe extension

The pathophysiology, clinical presentation, and intervention considerations for these lower extremity conditions are covered in the next chapter, Comparing clinical presentation and interventions for lower extremity.

Key points

Anterior drawer test

  • Position: supine, foot off mat, ankle 20° plantarflexion; therapist translates talus anteriorly
  • Tests anterior talofibular ligament (ATFL), most commonly injured in inversion sprains
  • Positive: excessive anterior translation vs. uninvolved side and/or pain

Talar tilt test

  • Position: sitting, knee bent, ankle neutral (90°); stabilize distal tibia, move foot into adduction (tests calcaneofibular ligament) and abduction (tests deltoid ligament)
  • Inversion = calcaneofibular ligament (common sprain mechanism); eversion = deltoid ligament (less common)
  • Positive: laxity vs. uninvolved side and/or pain

Thompson’s test

  • Position: prone, foot off mat; squeeze calf muscle, normal response = ankle plantarflexion
  • Tests Achilles tendon integrity; mechanism often sudden push-off/jump with “pop” and weight-bearing difficulty
  • Positive: no foot movement → red flag for Achilles rupture; stop and report to PT for prompt physician/orthopedic referral

Windlass test

  • Weight-bearing: standing, toes over step edge, passively dorsiflex great toe
  • Non-weight-bearing: seated, knee at 90°, stabilize ankle, passively dorsiflex great toe
  • Tests for plantar fasciitis (classic first-step morning heel pain)
  • Positive: reproduction of heel/plantar fascia pain at end-range toe extension

General PTA role

  • These tests gather objective data within plan of care
  • Document positive findings and report to supervising PT
  • Follow-up pathophysiology/intervention details covered in next chapter

More from Special tests of lower extremity

  • Hip special tests
  • Knee special tests