Purpose: To test for injury to the lateral ligaments of the ankle.
Test Position: Supine or sitting.
Performing the Test: The examiner stabilizes the distal leg in a neutral position and inverts the ankle. The examiner then determines how much inversion is present. The amount present is graded on a 4 point scale of 0-3, with 0 being no laxity and 3 being gross laxity. Flynn describes an alternate method of grading as <5 degrees, 5-15 degrees, or >15 degrees. Under anesthesia, >15 degrees was associated with complete rupture of both the anterior talofibular ligament and calcaneofibular ligament.
Diagnostic Accuracy: Unknown
Importance of Test: When assessing inversion and eversion motion at the ankle, you are describing motion that occurs parallel to the frontal plane (This motion is not to be confused with supination, which is a combination of inversion, adduction, and plantar flexion). By placing the patient in a position of inversion, you are stressing the lateral ligaments of the ankle. The degree to which lateral ligament is placed under the greatest stretch is debatable. An article written by Docherty et al believes that the calcaneofibular ligament is the primary ligament being stretched during the talar tilt test. This ligament courses from apex of the lateral malleolus inferiorly and posteriorly to the lateral calcaneus. During an inversion moment, a stress will be placed upon this ligament. If injury has occurred to the lateral ankle, the lateral ankle ligaments could be lax and increased inversion motion may be present.
Note: these tests should only be performed by properly trained health care practitioners
Reference:Flynn, Timothy. "Users Guide to the Musculoskeletal Examination." Docherty, Carrie. "Reliability of the Anterior Drawer and Anterior Tilt Tests using the Ligmaster Joint Arthometer." 2009. Neumann, Donald. Kinesiology of the Musculoskeletal System. 2nd Edition.