Heel Thump Test | Syndesmosis Injury Assessment

A high ankle or syndesmotic sprain is an injury to the distal tibiofibular syndesmosis. The distal joint is stabilized by several ligaments. The injury most often occurs in sports and return to play times might be twice as long as in usual ankle sprains.

According to Hunt et al. (2015), the mechanism of injury is a “forced external rotation of the foot while in a dorsiflexed position. The talus forces the fibula to separate from the tibia, rotate externally, and displace posteriorly, resulting in abnormal stress on the syndesmotic ligaments.”

The test was first described by Lindenfeld (2005) and considered positive when it produced pain over the anterior or posterior aspect of the ankle or in the distal leg, corresponding to the area of the anterior or posterior tibiofibular ligament and interosseous membrane, respectively.

A positive test suggests a syndesmotic sprain diagnosis only when other associated injuries around the ankle are ruled out by examination and radiographs.

The heel-thump test lacks evidence in the literature, making it of questionable clinical utility.

The test is performed with your patient in a seated position and with a relaxed ankle. The ankle will be slightly plantar flexed due to gravity. The lower leg is stabilized when the examiner gives a firm thump on the center of the calcaneus. The force should be directed along the axis of the tibia.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other common orthopedic tests for syndesmosis injuries are:

• Dorsiflexion External Rotation Stress Test / Kleiger’s Test
• Syndesmosis Ligament Tenderness
• Cotton Test
• Fibular Translation Test
• Syndesmosis Signs & Symptoms
• Crossed Leg Test

Hunt, K. J., Phisitkul, P., Pirolo, J., & Amendola, A. (2015). High ankle sprains and syndesmotic injuries in athletes. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 23(11), 661-673.

Lindenfeld, T., & Parikh, S. (2005). Clinical tip: heel-thump test for syndesmotic ankle sprain. Foot & ankle international, 26(5), 406-408.