Ankle Physical Exam

Inspection Anterior
Inspection Posterior
Range of Motion
Squeze Test
External Rotation Test

Ankle Circumduction Test
Anterior drawer Test
Hyperdorsiflexion sign
O'Brien Needle Test
Thompson's Test

Malleolar percussion Test

  Inspection Anterior
  Inspection Posterior
  Range of Motion
  Squeeze Test: indicates syndesmotic injury.  
  External Rotation Test
  Thompson's Test = squeeze calf muscle with pt prone, feet extended off end of table.  The foot plantar flexes if tendon is intact.  No foot movement =  ruptured Achilles. (Thompson TC, J Trauma 1962:2:126)


O'Brien Needle Test = 25-gauge needle inserted must medial to the midline 10cm proximal to the superior border of the calcaneous. Foot is passively dorsi/plantar flexed. Needle movement in the opposite direction of the foot indicates the tendon is intact. No movement = postive test = Achilles tendon completely ruptured. Positive Thompson test with negative O'Brien test indicates parital rupture of the musculotendinous junction of theGastrocnemius. (O'Brien T, JBJS 1984;66A:1099)


Hyperdosiflexion Sign = with patient prone and both knee flexed 90º, maximal passive dorsiflexion demonstrates increased dorsiflexion in patients with ruptured Achilles Tendon.


Anterior Drawer Test:

  • Anterior force is applied to the ankle with the joint in 10 degrees of plantar flexion.  Patient should be sitting with knees flexed over the edge of the table. 
  • Positive test (8-10mm of tanslation) indicates anterior talofibular ligament rupture; possible calcaneofibular ligament injury. 
  Ankle Circumduction test: Indicates Peroneal tendon instability.
  Malleolar percussion Test: Indicates medial or lateral malleolus ankle fracture.

Lateral talar tilt test

  • angle measurement greater than 15 degrees indicates rupture of both anterior talofibular ligament and calcaneofibular ligaments.

Silfverskiöld test

  • <5° of dorsiflexion with the knee extended that improved to >10° with the knee flexed indicates isolated gastrocnemius contracture
  • Silfverskiold N. Reduction of the uncrossed two-joints muscles of the leg to one-joint muscles in spastic conditions. Acta Chir Scand. 1924;1924(56):315-30.