Ankle & Foot
Syndesmosis (High Ankle Sprain)
Evidence: suggestive
Cotton Test Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Assessing instability of the syndesmosis (lateral talar shift).
How to Perform
- Stabilization: Hold the lower leg steady with one hand.
- Action: Grasp the foot (talus) and apply a sideways (lateral) force.
Interpretation of Results
- Positive Test: Feeling a "clunk" or excessive movement (>3-5mm) indicates widening of the syndesmosis.
Clinical Context & Limitations
The Cotton 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 Cotton Test with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment (7th ed.). Elsevier.
