Ankle & Foot Assessment

Talar Tilt Test | Ankle Sprain | Inversion Trauma

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Talar Tilt Test

Talar Tilt Test | Ankle Sprain | Inversion Trauma

The Talar Tilt Test is a common orthopedic test to be performed after an inversion trauma in order to assess the lateral ankle ligaments.
It assesses the lateral ligaments of the ankle in three different positions. This way, the anterior talofibular ligament, the calcaneofibular ligament as well as the posterior talofibular ligament can be assessed. In the fourth step, the test assesses the deltoid ligament complex on the medial side of the ankle.

According to Hertel et al. (1999) the talar tilt test has a sensitivity of 50% and a specificity of 88% in the diagnosis of lateral ankle sprains.
Rosen et al. (2015) rated the test on it’s ability to detect talocrural and subtalar joint instability by the degree of gapping and found a sensitivity of 4% and specificity values ranging from 78-88%. For this reason, the test’s clinical value is moderate.

To do the test, have your patient sitting with his knee hanging off of the table. In order to test the anterior talofibular ligament (aTFL), bring your patient’s foot into plantarflexion, so that the aTFL is perpendicular to the movement that you are going to perform. Then grab the calcaneus and perform inversion.

In order to test the calcaneofibular ligament (CFL), bring your patient’s foot into the anatomical position, so that this ligament is perpendicular to the long axis of the talus. Then bring the foot into inversion and eversion. The eversion part of this test, stresses the deltoid ligament complex on the medial side. And lastly, to put the most stress on the posterior talofibular ligament (pTFL), bring the foot into maximal dorsiflexion and perform the same movement again.

This test in different positions is considered positive, if the patient reports pain or if you find excessive gapping compared with the unaffected side.

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Another common test to assess for ligament injuries at the ankle is the Anterior Drawer Test at the ankle.

 

References

Hertel J, Denegar CR, Monroe MM, Stokes WL. Talocrural and subtalar joint instability after lateral ankle sprain. Medicine and science in sports and exercise. 1999 Nov 1;31(11):1501-8.

Rosen, A. B., Ko, J., & Brown, C. N. (2015). Diagnostic accuracy of instrumented and manual talar tilt tests in chronic ankle instability populations. Scandinavian Journal of Medicine & Science in Sports, 25(2), e214-e221.

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