Forced Dorsiflexion Sign | Anterior Ankle Impingement Assessment

Anterior Ankle impingement is a condition involving synovial hypertrophy, cartilage proliferation, scar tissue formation, calcification, and or osteophyte formation in the anterolateral gutter. It’s a result of trauma, specifically dorsiflexion trauma, ankle inversion trauma, or repetitive stress. Most patients report a history of these traumas and report chronic anterolateral ankle pain and or limited dorsiflexion.

The forced dorsiflexion test as described by Molloy et al. (2003) has a sensitivity of 94,8% and a specificity of 88%. We have to be careful with the interpretation of these results as the study is at risk of bias which is why we attribute this test a moderate clinical value.

To conduct the test, have the patient in sitting position and grasp the calcaneus with one hand and use the thumb of that same hand to apply pressure over the anterolateral part of the ankle. This might already cause discomfort but is not considered a positive test.
Consequently, use your other hand to move the foot into maximal dorsiflexion while you keep applying pressure with the other thumb.

A positive test results in the reproduction of your patient’s pain or if pain elicited by applying pressure with the thumb is increased.
The assumed mechanism is that hypertrophic synovium is forced into the joint and impinges between the talus and lateral malleolus during forced dorsiflexion resulting in pain.
Joint osteophytes and cartilage proliferation may further limit ankle dorsiflexion.

Other interesting wiki entries to help your diagnosis of ankle impingement are:

• Signs & Symptoms of Anterior Ankle Impingement
• Heel Thrust Test (Posterior Impingement)

Molloy, S., Solan, M. C., & Bendall, S. P. (2003). Synovial impingement in the ankle: a new physical sign. The Journal of Bone and Joint Surgery. British volume, 85(3), 330-333.