Anterolateral Drawer Test Ankle

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The anterolateral drawer test to assess subtalar joint laxity. The tibia is stabilized and the hindfoot is held with maximum ankle dorsiflexion to lock the joint in the ankle mortise and avoid tibiotalar movement. Then, (A) anterior stress is applied at the posterior calcaneus, (B) combined with inversion, internal rotation, and adduction of the forefoot, as shown by arrows.

• Anterolateral Drawer Test Ankle

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Purpose

• Evaluate for ligamentous laxity or instability of the Ankle Joint
  • Essentially combines the Anterior Drawer Test Ankle and Talar Tilt Test

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Description

• Stabilize anterior leg with one hand, grasp calcaneus with other
• Examiner then places the patient's foot into 10-15° of plantar flexion, translates the rear foot anteriorly
• The thumb is placed along the relatively smooth plane formed by the lateral aspect of the anterior talar dome and the anterior aspect of lateral malleolus 1 cm proximal to its tip.
• Anterior translation is applied at the posterior aspect of the heel while the foot is allowed to rotate internally and any step-off is palpable by the thumb.
• Positive test
  • Translation of talus anteriorly
  • Graded on a "0 to 3 scale", with 0 indicating no laxity & 3 indicating gross laxity.

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Pathology

• Lateral Ankle Sprain
• Chronic Ankle Instability

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Evidence

Chronic Lateral Ankle Instability

• Cadaveric study by Phisitkul et al
  • Sensitivity 100%
  • Specificity 100%

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See Also

• Physical Exam Ankle
• Ankle Pain Main
• Ankle Anatomy Main

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