Special Tests

Steps: Athlete is sitting over the edge of the table with the knee bent; Examiner stabilizes the lower leg with one hand & cups the calcaneus with the forearm supporting the foot in slight plantar flextion (~ 20° ) and slight inversion (few degrees); Examiner draws the calcaneus & talus anteriorly and slighlty medially
Positive Test: Pain, anterior translation, dimple/sulcus, and/or "clunk"
Positive Test Implications: ATF ligament sprain/capsular sprain
See Test

Steps: Athlete is sitting or lying supine, with the involved foot off the end of the table & the knee straight; Examiner stabilizes the lower leg with one hand & bumps the calcaneus with the other hand; Examiner bumps the calcaneus 2–3 times with progressively more force
Positive Test: Pain (at area of complaint)
Positive Test Implications: Possible fracture
See Test

Steps: Athlete is sitting or lying with his/her knee extended; Examiner cups his/her hands behind the tibia & fibula, away from the site of pain; Examiner compresses the tibia & fibula, gradually adding more pressure
Positive Test: None
Positive Test Implications: Possible fracture
See Test

Steps: Athlete is supine or sitting with his/her knees extended; Examiner stands lateral to the involved foot; Examiner stabilizes the proximal bone close to the joint to be tested; Examiner grasps the bone distal to the joint to be tested near the middle of its shaft; Examiner moves the distal bone medially/laterally, attempting to open up the joint
Positive Test: Increased laxity or pain
Positive Test Implications: Collateral ligament sprain
See Test

Steps: Athlete is supine with the hip of the affected side externally rotated and the foot slightly everted; Examiner taps over the tarsal tunnel
Positive Test: Radiating pain in the foot and toes
Positive Test Implications: Tarsal tunnel syndrome
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Steps: Athlete is prone with his/her knee extended; Examiner squeezes the calf musculature while observing for ankle plantar flexion
Positive Test: Foot does not plantar flex when calf is squeezed
Positive Test Implications: Achilles tendon rupture
See Test

Steps: Athlete is sitting on the edge of the table; Examiner is positioned on a stool facing the athlete; Examiner notes the presence of a medial longitudinal arch; Examiner has the athlete stand with his/her body weight evenly distributed
Positive Test: Medial longitudinal arch disappears when weight bearing
Positive Test Implications: Supple Pes Planus
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Steps: Athlete is sitting (or supine with the knee slightly flexed); Examiner stabilizes the lower leg with one hand; Examiner grasps the rearfoot and slides the talus/calcaneus laterally and medially
Positive Test: Pain; noticeable "clunk"; Positive Test Implications
Syndesmosis sprain: None
See Test (Medial Subtalar Glide)
See Test (Lateral Subtalar Glide or Cotton)

Steps: Athlete is sitting with the involved leg off the end of the table; Examiner taps distally from the involved structure
Positive Test: Pain (at the area of complaint only)
Positive Test Implications: Possible fracture
See Test

Steps: Athlete is sitting with both feet on the floor; Examiner places a dot over the navicular tuberosity with the athlete in a non–weight bearing position; Examiner kneels in front of the athlete & places the subtalar joint in the neutral position with the athlete's foot flat against the ground, but non–weight bearing; Examiner positions a 3x5 index card next to the medial longitudinal arch & makes a mark on the card corresponding to the level of the navicular; Examiner has the athlete stand with his/her body weight evenly distributed & marks the new level of the navicular on the card; Examiner measures the distance between the two marks
Positive Test: Navicular drops more than 10 mm
Positive Test Implications: Hyperpronation of the foot
See Test

Steps: Athlete is sitting with his/her legs over the edge of the table; Examiner stabilizes the lower leg with one hand; Examiner grasps the medial aspect of the foot while supporting the ankle in neutral; Examiner rotates the foot laterally
Positive Test: Medial/lateral joint pain; syndesmosis (anterior Tib–fib) pain
Positive Test Implications: Deltoid ligament sprain (medial/lateral joint pain); syndesmosis involvment (syndesmosis/tib–fib pain)
See Test

Steps: Athlete is sitting with his/her legs over the edge of the table; Examiner grasps the calcaneus with one hand & stabilizes the lower leg with the other hand; Examiner provides inversion stress rolling the calcaneus inward while the ankle is in neutral; Examiner provides an inversion stress by rolling the calcaneus inward while the ankle is in the plantar flexed position
Positive Test: Talus tilts or gaps excessively; pain
Positive Test Implications: Involvement of ATF (PF position)/CF (neutral position)
See Test

Steps: Athlete is sitting with his/her legs over the edge of the table; Examiner grasps the calcaneus with one hand & stabilizes the lower leg with the other hand; Examiner provides an eversion stress rolling the calcaneus outward while the ankle is neutral
Positive Test: Talus tilts or gaps excessively; pain
Positive Test Implications: Deltoid ligament sprain
See Test

Steps: Athlete is supine or sitting with his/her knees extended; Examiner is standing in front of the athlete's feet; Examiner grasps the heads of the two metatarsals; Examiner moves the two metatarsal heads in opposite directions; Examiner repeats the procedure until all four intermetatarsal joints have been evaluated
Positive Test: Pain or increased glide
Positive Test Implications: Trauma to deep transverse metatarsal ligament and/or interosseus
See Test

Steps: Athlete is positioned in the supine position on the table; Examiner uses the eraser end of a pencil to apply pressure to the intermetatarsal space
Positive Test: Replication of symptoms/increase of symptoms
Positive Test Implications: Interdigital neuroma
See Test

Steps: Athlete is sitting or supine with the knee extended; Examiner passively dorsiflexes foot while knee is extended; Examiner palpates the calf
Positive Test: Calf pain
Positive Test Implications: Deep vein thrombophlebitis (DVT)
See Test

Steps: Athlete is supine or seated with his/her feet off teh end of the table; Examiner grasps the foot around the mid–shaft of the metatarsals & squeezes metatarsals or compresses the bone from one end to the other and rotates the bone
Positive Test: Pain and/or crepitus
Positive Test Implications: Possible MT fracture
See Test (Grind)
See Test (Compression)

Steps: Athlete is sitting with his/her feet off the end of the table; Examiner places a mark on the apex of the medial malleolus, the navicular tubercle & the plantar aspect of the 1st MTP joint & draws a line connecting the marks; Examiner has the athlete stand with his/her feet approximately 1' apart & the weight evenly distributed; Examiner marks the new position of the navicular tubercle
Positive Test: Navicular drops more than 10 mm
Positive Test Implications: Hyperpronation of the foot
See Test