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Home› Physical Therapy› Free Self-Checks› Special Tests› Ankle & Foot

Ankle & Foot Special Tests

Fracture screening, ligament, Achilles and plantar fascia tests for the ankle and foot.

Reviewed by Dr. Richard Holsman, PT, DPT, NCS · Last reviewed November 13, 2026 · For clinician education

⚠️ For clinicians

For clinician education; special tests support but do not replace a full examination. This page is a reference for physical therapists, occupational therapists, athletic trainers, students and other clinicians. Patients with joint or spine pain should be examined by a licensed clinician.

After an ankle injury, start with the Ottawa ankle rules. Ligament testing is more accurate a few days after the injury than in the first 48 hours.

On this page

Accuracy at a glance

TestTarget conditionSnSp+LR−LRSource
Ottawa ankle rulesAnkle fracture (pooled)Almost 100%Modest—0.08[1]
Anterior drawer test (ankle)Ankle ligament rupture, delayed physical exam about 5 days after injury (includes the drawer test)96%84%——[2]
Talar tilt testAccuracy data not verified—
Thompson testComplete Achilles tendon rupture96%93%——[3]
Squeeze test (syndesmosis)Accuracy data not verified—
Windlass testPlantar fasciitis, weight-bearing32% (7 of 22)No positives in 53 people without plantar fasciitis——[4]

Sn = sensitivity, Sp = specificity, LR = likelihood ratio. A dash means the source we checked did not report that value.

How to read the accuracy numbers

  • Sensitivity: of people who have the condition, the share with a positive test. A highly sensitive test that is negative helps rule the condition out.
  • Specificity: of people without the condition, the share with a negative test. A highly specific test that is positive helps rule it in.
  • Positive likelihood ratio (+LR): how much a positive result raises the odds. About 5–10 is a moderate shift; above 10 is large.
  • Negative likelihood ratio (−LR): how much a negative result lowers the odds. About 0.1–0.2 is a moderate-to-large shift; near 1 means little change.
  • Values depend on the study’s patients, examiners and reference standard. Many studies are small, so treat single-study numbers with caution.

Ankle & Foot special tests, step by step

Each test is described in our own words. Compare with the uninvolved side and stop if the test provokes severe pain.

Ottawa ankle rules

Purpose
Decide who needs an X-ray after acute ankle or midfoot injury.
Patient position
Any position; includes a walking check.
How to perform[5]
  1. Palpate the back edge and tip of the lateral malleolus (bottom 6 cm), the back edge and tip of the medial malleolus (bottom 6 cm), the base of the fifth metatarsal and the navicular.
  2. Ask the patient to take four steps (two on each foot), now and right after the injury.
Positive finding
X-ray is indicated if there is bone tenderness at any of those points or the patient cannot take four steps.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Ankle fracture (pooled)[1]Almost 100%Modest—0.08
Midfoot −LR also 0.08; children 0.07.

Anterior drawer test (ankle)

Purpose
Tests the anterior talofibular ligament (ATFL).
Patient position
Sitting or supine, knee bent, ankle in about 10–20° of plantarflexion.
How to perform[5]
  1. Stabilize the distal tibia with one hand.
  2. Cup the heel with the other hand and pull the foot forward.
Positive finding
Increased forward slide of the talus compared with the other side, sometimes with a dimple (suction sign) in front of the lateral malleolus.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Ankle ligament rupture, delayed physical exam about 5 days after injury (includes the drawer test)[2]96%84%——
Accuracy of the delayed exam as a whole, not the drawer alone; less accurate within 48 hours.

Talar tilt test

Also called: Inversion stress test

Purpose
Tests the calcaneofibular ligament.
Patient position
Sitting or side-lying, ankle neutral.
How to perform[5]
  1. Stabilize the distal tibia.
  2. Hold the heel and tilt the talus and calcaneus into inversion.
Positive finding
More tilt than the other side, and/or pain over the ligament.

Diagnostic accuracy

Accuracy data not verified. We did not find a diagnostic accuracy study for this test that we could check, so we show no numbers.

Thompson test

Also called: Calf squeeze test, Simmonds test

Purpose
Checks for a complete Achilles tendon rupture.
Patient position
Prone with the feet hanging off the end of the table (or kneeling on a chair).
How to perform[5]
  1. Squeeze the middle of the calf.
  2. Watch the foot and compare with the other side.
Positive finding
No plantarflexion of the foot when the calf is squeezed.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Complete Achilles tendon rupture[3]96%93%——
Gap palpation 73% sensitive (89% specific); Matles test 88% sensitive (85% specific).

Squeeze test (syndesmosis)

Purpose
Screens for a high ankle sprain (distal tibiofibular syndesmosis).
Patient position
Sitting or supine.
How to perform[5]
  1. Squeeze the tibia and fibula together at mid-calf.
Positive finding
Pain at the front of the ankle, above the joint line, away from where you are squeezing.

Diagnostic accuracy

Accuracy data not verified. We did not find a diagnostic accuracy study for this test that we could check, so we show no numbers.

Windlass test

Purpose
Tensions the plantar fascia for plantar fasciitis.
Patient position
Standing on a step with the toes hanging over the edge (weight-bearing), or sitting.
How to perform[5]
  1. Passively lift the big toe into full extension.
  2. Hold up to 30 seconds.
Positive finding
Familiar heel or arch pain.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Plantar fasciitis, weight-bearing[4]32% (7 of 22)No positives in 53 people without plantar fasciitis——
Non-weight-bearing sensitivity 14% (3 of 22). Low sensitivity limits use.

What we left out

External rotation (Kleiger) test, Tinel’s at the tarsal tunnel, Mulder’s click, and accuracy numbers for talar tilt and the squeeze test were not verified. We only show accuracy numbers we could check against the original study or review.

Sources, review and disclosures

Graded citations

How we grade sources. A = systematic review or meta-analysis. B = single prospective diagnostic accuracy study. C = small, retrospective or case-control study, or a clinical prediction rule that has only been derived (not yet validated). D = expert clinical opinion (our test descriptions). Every accuracy number on this page was checked against the cited abstract or full text on November 13, 2026. If we could not check a number, we left it out and say “accuracy data not verified.”

  1. Grade A Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003;326(7386):417. doi:10.1136/bmj.326.7386.417 (abstract; full text free at PMC149439). PubMed 12595378
  2. Grade B van Dijk CN, Lim LS, Bossuyt PM, Marti RK. Physical examination is sufficient for the diagnosis of sprained ankles. J Bone Joint Surg Br. 1996;78(6):958-962. doi:10.1302/0301-620x78b6.1283 (abstract; 160 patients). PubMed 8951015
  3. Grade B Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon: a prospective study in 174 patients. Am J Sports Med. 1998;26(2):266-270. doi:10.1177/03635465980260021801 (abstract). PubMed 9548122
  4. Grade C De Garceau D, Dean D, Requejo SM, Thordarson DB. The association between diagnosis of plantar fasciitis and Windlass test results. Foot Ankle Int. 2003;24(3):251-255. doi:10.1177/107110070302400309 (abstract; 22 patients with plantar fasciitis). PubMed 12793489
  5. Grade D Holsman Physical Therapy clinical guidance. Patient position, test steps and positive findings written in our own words by Holsman physical therapists and reviewed by Dr. Richard Holsman, PT, DPT, NCS. Expert opinion, not a research source.

Reviewer

Reviewed by Dr. Richard Holsman, PT, DPT, NCS (Board-Certified Clinical Specialist in Neurologic Physical Therapy), founder of Holsman Physical Therapy. Last reviewed: November 13, 2026.

Change log

  • November 13, 2026: Page published. Test descriptions written in our own words; accuracy values checked against the cited sources.

Review policy

We re-check every number on this page against its source at least once a year, and sooner if a source is updated, a better study is published or a reader reports a problem. Changes are listed in the change log with the date. To report an error, contact us.

Licensing

Test descriptions, steps and the accuracy summaries are original text by Holsman Physical Therapy. Accuracy values are individual numbers cited with credit to the original studies; no tables, figures or text from journals, textbooks or other websites are reproduced. Linking to a source does not imply its endorsement. Demonstration videos, when added, will be filmed by Holsman physical therapists with consenting adult models.

Conflict of interest and advertising

This page is published by Holsman Physical Therapy and Wellness, P.C., which runs outpatient and in-home therapy practices; that is our only commercial interest. The page carries no advertising, no sponsorship and no affiliate links, and we received no payment from any source for it. Holsman Physical Therapy is not affiliated with the authors or publishers cited, and they do not endorse this website.

For clinician education; special tests support but do not replace a full examination. A positive or negative test changes the probability of a condition; it does not make a diagnosis. Interpret every result with the history, the rest of the examination, imaging when indicated, and clinical judgment. Stop any test that provokes severe pain or neurological symptoms.

Common Questions

Do the Ottawa ankle rules really rule out a fracture?

Yes, they are very reliable for excluding fractures. A 2003 systematic review of 27 studies found a pooled negative likelihood ratio of 0.08 for the ankle and midfoot, with sensitivity close to 100%.

When is the best time to test ankle ligaments?

About five days after the injury. In van Dijk 1996, a delayed physical exam had 96% sensitivity and 84% specificity for ligament rupture and was more accurate than an exam within 48 hours.

Referring a Patient?

Holsman physical therapists see patients at clinics across North Jersey, the Bronx and Brooklyn, plus in-home visits.

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