Anterior drawer test (ankle)
Gently drawing the heel bone forward while stabilizing the shin assesses the integrity of the anterior talofibular ligament following a suspected sprain.
Assessment of the ankle and foot typically begins with a history of the injury mechanism or symptom onset, followed by observation of swelling, bruising, and weight-bearing ability.
A structured examination including specific ligament and tendon tests, alongside clinical decision rules for imaging, helps guide appropriate management from the first visit.
Assessment tests
Ottawa ankle rules
A clinical decision tool based on specific areas of bony tenderness and weight-bearing ability that helps identify which ankle injuries need imaging to rule out fracture.
Thompson test
Squeezing the calf while the patient lies face-down and observing for ankle movement helps identify a complete Achilles tendon rupture.
Windlass test
Extending the big toe while the foot is weight-bearing stretches the plantar fascia and can reproduce heel pain characteristic of plantar fasciitis.
Single-leg balance test
Standing on one leg with eyes open or closed assesses balance and proprioceptive control, often reduced following ankle sprain and relevant to chronic instability.
Red flags
These warrant prompt clinical review rather than unsupervised exercise progression.
Inability to bear weight after injury
An inability to take even a few steps immediately after an ankle injury, combined with specific bony tenderness, raises concern for fracture and typically warrants imaging.
Visible deformity
An obvious change in the shape of the ankle or foot after injury suggests possible fracture or dislocation and requires urgent evaluation.
Sudden calf pain with an audible pop
A sudden sharp pain at the back of the ankle with an audible pop during push-off may indicate an Achilles tendon rupture and should be assessed promptly.
Signs of compromised circulation
A cold, pale, or numb foot following injury is a medical emergency requiring immediate evaluation.
This structured approach, combining clinical decision rules with targeted special tests, allows the majority of ankle and foot injuries to be confidently managed without unnecessary imaging while still identifying those that need it.
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