“How do you test for ankle instability?”
I am a 49 year old female. I want to know how do you test for ankle instability?
16 Answers
When chronic ankle instability is present, it can also be divided into functional and mechanical instability.
Mechanical instability involves pathologic joint laxity. This is typically delineated by a talar tilt discrepancy greater than to 10 degrees or an anterior drawer difference of 10 mm compared to the contralateral ankle.
Functional instability is ascribed to sensorimotor and neuromuscular deficits that accompany ligamentous injury, but mechanical instability is not necessarily present.
Physical Examination
The initial patient evaluation starts with an assessment of standing hindfoot alignment. The contralateral ankle should be evaluated for range of motion, strength, ankle drawer and associated forefoot and hindfoot abnormalities. This gives the examiner an appreciation for the patient’s baseline exam. The exam is then repeated in the same manner on the pathologic side, noting the discrepancies between sides. Additionally, particular attention should be paid to peroneal strength, subluxation/dislocation, or pain.
The inversion test evaluates the integrity of the CFL. This is performed by first dorsiflexing the ankle to neutral and then inverting the hindfoot. Increased laxity is highly specific for CFL injury. The anterior drawer test is performed with one hand stabilizing the tibia and the contralateral hand cupping the heel and pulling forward. If the ATFL is disrupted the talus will translate anteriorly and with a more subtle internal rotation because of the intact medial structures. Other contributing factors such as hindfoot varus, plantarflexion of the first ray, and midfoot cavus should be evaluated.
Imaging
Plain radiographs, including anteroposterior (AP), lateral, and mortise views of the ankle, should be obtained to evaluate for boney pathology. Stress radiographs including anterior drawer and talar tilt may be helpful when indicated. MRI of the ankle without contrast is important to evaluate for other associated pathology, in particular peroneal tendon tears and osteochondral lesions, when the physical exam warrants.
Mechanical instability involves pathologic joint laxity. This is typically delineated by a talar tilt discrepancy greater than to 10 degrees or an anterior drawer difference of 10 mm compared to the contralateral ankle.
Functional instability is ascribed to sensorimotor and neuromuscular deficits that accompany ligamentous injury, but mechanical instability is not necessarily present.
Physical Examination
The initial patient evaluation starts with an assessment of standing hindfoot alignment. The contralateral ankle should be evaluated for range of motion, strength, ankle drawer and associated forefoot and hindfoot abnormalities. This gives the examiner an appreciation for the patient’s baseline exam. The exam is then repeated in the same manner on the pathologic side, noting the discrepancies between sides. Additionally, particular attention should be paid to peroneal strength, subluxation/dislocation, or pain.
The inversion test evaluates the integrity of the CFL. This is performed by first dorsiflexing the ankle to neutral and then inverting the hindfoot. Increased laxity is highly specific for CFL injury. The anterior drawer test is performed with one hand stabilizing the tibia and the contralateral hand cupping the heel and pulling forward. If the ATFL is disrupted the talus will translate anteriorly and with a more subtle internal rotation because of the intact medial structures. Other contributing factors such as hindfoot varus, plantarflexion of the first ray, and midfoot cavus should be evaluated.
Imaging
Plain radiographs, including anteroposterior (AP), lateral, and mortise views of the ankle, should be obtained to evaluate for boney pathology. Stress radiographs including anterior drawer and talar tilt may be helpful when indicated. MRI of the ankle without contrast is important to evaluate for other associated pathology, in particular peroneal tendon tears and osteochondral lesions, when the physical exam warrants.
There are a lot of ways to test this, most common is having a physical exam done of the ankle by a podiatrist trained in ankle injuries. I am trained in sports medicine and this is a simple in office exam. Sometimes can do stress xrays where someone is pushing or moving your ankle a certain way and based on the xrays we can tell if ligaments are torn or loose. MRI is another way to look at the ligaments and see tears. But a good exam is all that is needed.
Ankle instability can evaluated clinically by a podiatrist who will check multiple areas of the ankle and surrounding ligaments and also by measuring the range of motion of certain joints, and finally gait analysis.
These tests are very hands on and it is impossible to teach you over written words. Sprained ankles or instability usually do not need surgery, unless left untreated for some time.
Following a detailed history and examination, which includes comparison of motion of the ankle compared to the same motion on the opposite ankle, we can use diagnostic testing of X-rays or stress X-rays with and without local anesthesia, as indicated along with comparison of symptoms with diagnostic tapings to determine the functional as well as the anatomical stability of the ankle.
Jan David Tepper, D.P.M.,FACFASCEO
Jan David Tepper, D.P.M.,FACFASCEO
Testing for ankle instability needs to be performed by a practicing physician or physical therapist. If the patient himself thinks the ankle is unstable and needs professional advice as to the cars and affect are his instability.
Thank you,
Dr. Mark Gorman
Thank you,
Dr. Mark Gorman
There are x-ray techniques that can be done under anesthesia. MRI can be performed to look at the ankle ligaments.
Jonathan M. Kletz, DPM
Texas Foot Works Dallas, Athens and Gun Barrel City Texas 214-340-8885
Jonathan M. Kletz, DPM
Texas Foot Works Dallas, Athens and Gun Barrel City Texas 214-340-8885
The ankle has ligaments on the inside and outside which stable the ankle structures. When these ligaments are damaged the ankle can slide forward or backward with excessive motion. The excessive turning in of the ankle can also be a sign of instability.
Ankle instability can be tested by physical examination of by a test called stress X ray of the ankle. I recommend you make an appointment with a foot and ankle surgeon (podiatrist) for evaluation
For yourself at home, you can make yourself a balance board. Find a 2 x 2 foot board and put a golf ball under the center of it. Stand on top of the middle of the board and try to balance yourself. You may hold on to something with your hand to feel steady. If you have a hard time balancing or there is pain, then you have ankle instability, See your doc for treatment options
Ankle instability is tested clinically by putting the ankle through 2 different tests: 1) Anterior Drawer test 2) Talar Tilt test. These can also be done under fluoroscopy or under plain film radiology. Further testing is done by performing an MRI to see if ligaments are sprained (stretched out) or ruptured (torn completely or partially). It is also decided based on frequency of patient ankle sprains and a 'feeling' by the patient of instability and that they are frequently feeling as if they are going to sprain the ankle, or they are afraid to do things because they frequently sprain their ankles