Ankle Anterior Drawer Test Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Diagnosing injuries to the Anterior Talofibular Ligament (ATFL).
- Assessing ankle instability.
How to Perform
- Position: Patient lies on their back (supine) with the foot relaxed.
- Stabilization: Hold the lower leg (tibia and fibula) steady with one hand.
- Action: Place the foot in slight plantar flexion (20°), grasp the heel (calcaneus), and pull the foot forward.
Interpretation of Results
- Positive Test: Excessive forward movement (translation) of the foot compared to the healthy side.
- Dimple Sign: A dimple may appear over the ligament area if pain is minimal.
Diagnostic Accuracy
- Sensitivity: 96-100% (Magee)
Clinical Context & Limitations
The Ankle Anterior Drawer Test should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Ankle & Foot region, combining the Ankle Anterior Drawer Test with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment (7th ed.). Elsevier.
- Miller, M. D. (2020). Miller's Review of Orthopaedics (8th ed.). Elsevier.
