Ankle anterior drawer

Name of test

Anterior drawer test of the ankle

What it tests

Integrity of the anterior talofibular ligament and calcaneo-fibular ligament

How to do it

For the RIGHT ankle: The patient sits on the examination table with their legs hanging freely over the end of the table. The examiner places the left hand over the distal tibia to secure the leg (first figure, red lines).

The examiner’s right hand grasps the hind foot (red lines, second figure). The index and long fingers should cup the patient’s heel.

To administer the test, the examiner applies an anterior force to the heel while stabilizing the leg (black lines).

The examiner assesses anterior movement of the talus by inspection and feel.

The test should be repeated in plantarflexion (last figure) to isolate the anterior talo-fibular ligament

The normal response

There should be minimal anterior translation of the talus.

Normally, anterior translation of the talus should not exceed a few mm, and there should be a firm endpoint to the anterior movement of the talus.

What it means if not normal

A soft endpoint, dimpling of the skin over the anterolateral aspect of the ankle joint, or more than a 3-5mm difference in anterior translation between the patient’s two ankles is pathologic and denotes laxity.

If the laxity is felt only when the foot is plantar flexed, the pathology is in the anterior talofibular ligament; laxity in dorsiflexion isolates the laxity to the calcaneo-fibular ligament .

Comments

This is an INDIRECT test (pulling forward for ligaments that resist side-to-side motion) as normal sub-talar inversion/eversion may give the examiner a false sense of instability.

As with all examinations in orthopaedics there is wide variance of normal between individuals, so remember to compare examination findings to patient’s contralateral side.

Involuntary guarding against ankle manipulation due to pain can increase false-negative results.