Dorsiflexion Eversion Test | Tarsal Tunnel Syndrome (TTS)

Tarsal Tunnel syndrome is a compressive neuropathy of the posterior tibial nerve or its branches, which can become entrapped in the tarsal tunnel under the deep fascia, flexor retinaculum and within the abductor hallucis muscle.

According to Kinoshita et al. (2001), the Dorsiflexion-Eversion Test has a sensitivity of 25% for an increase in numbness, 57% for an increase in pain, and 98% for an increase in tenderness with a specificity for all outcomes of 100%. If evaluated on tenderness it seems that this test has a high clinical value, although we have to remain diligent as this was the only study so far that has evaluated this test.

To conduct the test, have your patient in side-lying position so that the tibial nerve becomes accessible posterior to the medial malleolus. Then maximally dorsiflex the ankle, bring the foot into maximal eversion and bring the toes into maximal extension at the MCP joints hold this position for 5-10 seconds, while you palpate for tenderness on the tibial nerve.

This test is positive if the patient reports an increase in tenderness. Pain or numbness should not be rated as a positive test as the study has reported lower values for sensitivity in these cases.

Other orthopedic tests to assess tarsal tunnel syndrome are:

• Tinel’s Sign at the Ankle
• Triple Compression Stress Test

Kinoshita, M., Okuda, R., Morikawa, J., Jotoku, T., & Abe, M. (2001). The dorsiflexion-eversion test for diagnosis of tarsal tunnel syndrome. JBJS, 83(12), 1835-1839.