Ankle & Foot
Bone, Fracture & Joint Pathology
Evidence: suggestive
Heel Thump Test Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Screening for tibial stress fractures.
- Differentiating between a high ankle sprain (syndesmosis) and a lateral sprain.
How to Perform
- Position: Patient sits or lies down. Stabilize the leg with one hand.
- Action: Use your fist to firmly thump the bottom of the patient's heel.
- Direction: Ensure the force is applied in line with the long bone of the leg (tibia).
Interpretation of Results
- Syndesmosis Injury: Pain felt in the ankle joint area.
- Stress Fracture: Pain felt along the shin bone (tibia).
Clinical Context & Limitations
The Heel Thump 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 Heel Thump Test with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment (7th ed.). Elsevier.
