HIP SPECIAL TESTS

TESTS
Patricks Test
(Faber or FigureFour Test)

Sometimes
referred to
as
Jansens
test

FlexionAdduction Test
Used in
older
children
and young
adults
Quadrant
or
Scouring
Test
Trendelenburgs
Sign

Stinchfield
Resisted Hip
flexion Test

Anterior Labral
Tear Test
(FADDIR- Flexion,
Adduction, and
Internal Rotation
Test)

3PTA Batch 2015

Structure/Condition
Being Tested
If (+), the following
may be affected:
a. Hip joint
b. Iliopsoas
spasm
c. Sacroiliac
joint

Patient
Position
Supine;
Faber is the
beginning
position of
the hip.

Stabilization
None mentioned
(According
to
picture, PT holds
the knee of test
leg
and
the
opposite ASIS.)

Maneuver

(+) Sign

PT places pts test leg

so that the foot is on
top of the knee of
opposite leg. PT then
slowly lowers the knee
of test leg down toward
table.

(+) Test- Test

legs
knee
remains above the
opposite straight
leg.
(-) Test- Test legs
knee falling to the
table or at least
being parallel with
the opposite leg.
(+)
TestAdduction
is
limited
accompanied by
pain or discomfort.
(-) Test- Knee will
pass
over
opposite
hip
without rolling the
pelvis.

The test compresses

the femoral neck
against acetabulum;
pinches
adductor
longus,
pectineus,
ilipsoas, Sartorius or
tensor fascia lata.

Supine

None mentioned

PT flexes pts hip to 90

with knee flexed. PT
then adducts the flexed
leg.

-Stability of the hip

and ability of hip
adductors
to
stabilize pelvis on
femur
-Weak
gluteus
medius
Intra-articular
pathology which may
include:
a. Labral tear
b. Synovitis
c. Arthritis
d. Occult
femoral neck
fractures
e. Iliopsoas
tendinitis/bur
sitis
f. Prosthetic
failure
or
loosening
Tests:
a. Anteriorsuperior
impingement
syndrome
b. Anterior
labral tear
c. Iliopsoas
tendinitis

Standing

None

The pt is asked to
stand on one lower
limb.

Pelvis on opposite
side drops

Supine

None mentioned

Pt actively elevates the

straight leg to 20-30
while PT applies gentle
resistance.

Pain
may
be
referred
to
sensory
distribution
of
femoral, obturator,
or sciatic nerves.

PT takes hip into full

flexion, lateral rotation,
full abduction as a
starting position. PT
then
extends
hip
combined with medial
rotation and adduction.

Production of pain
or reproduction of
pts
symptoms
with or without a
click.

Supine

TESTS

Posterior Labral
Tear Test

McCarthy Hip
Extension Sign

Craigs Test
*also called
Ryder method

Torque Test

Nelatons Line

Structure/Condition
Being Tested

Patient
Position

One hand: on the

knee

Labral tear/
Anterior hip
instability/
Posterior-inferior
impingement

Supine

N/A

Supine w/
both hips
flexed

Femoral anteversion
(forward torsion of
femoral neck)

To test stability of
hip and its capsular
ligaments

hip dislocation or
coxa vara

Stabilization

Prone w/
knee flexed
to 90

Other hand: distal

leg, above the
ankles

N/A

One hand:
palpates for
greater trochanter
of femur
Other hand: distal
leg, above the
ankles

Maneuver
-Starting position: PT
fully flexes, adducts,
and medially rotates
hip
-Final position:
PT extends, abducts,
and laterally rotates hip
-PT takes unaffected
hip, extends and
laterally rotates it.
-Procedure is repeated,
but extension is
combined w/ medial
rotation.
-The test is repeated
with the affected hip.
-PT medially and
laterally rotates the hip
until the greater
trochanter is parallel w/
the table (or when it
reaches its most lateral
position).

-Test leg is extended

until the pelvis begins
to move.
-PT uses one hand to
One hand: distal
medially rotate femur to
Supine w/
leg, above the
end range, and the
femur of test
ankles
other hand to apply a
leg extended
slow posterolateral
over edge of
Other hand:
pressure along the line
the table
femoral neck
of femoral neck for 20
secs. (to stress
capsular ligaments and
test the stability of the
hip joint)
-It is an imaginary line from ischial tuberosity of the pelvis to
ASIS of the pelvis on the same side.
*two sides should be compared

TESTS
1. Bryants
Triangle

Structure/Condition
Being Tested
To determine the
upward displacement
of the trochanter in
fracture of the neck
of the femur

Patient
Position
Supine

Stabilization

(+) Sign
groin pain,
apprehension,
reproduction of
the patients
symptoms with or
without a click

reproduction of
the pts pain

The degree of
anteversion can
be estimated
based on the
angle of the lower
leg w/ vertical.
(an angle >15)

N/A

If greater
trochanter is
palpated above
the line

Maneuver

(+) Sign

PT
drops
an
imaginary
perpendicular
line
from ASIS to table.

Differences
may
indicate coxa vara
or
congenital
dislocation of hip

Second imaginary line

from the tip of greater
trochanter to meet the
first line at a right
angle.
Measure lines and
compare two sides.

3PTA Batch 2015

2. Rotational
Deformities

Rotation of femur or
tibia

Supine with
lower limbs
straight

Examiner looks at the

patellae

Fick Angle normal

feet angle 5 - 10
out for better balance

Squinting patella is
a
possible
indication of medial
rotation of femur or
tibia
Grasshopper/Frog
Eyes is a possible
indication of lateral
rotation of femur or
tibia
Pigeon toes (feet
face in) indicates
that the tibia is
affected, rotates
medially and face
out more than 10
excessive lateral
rotation of tibia

PEDIATRIC TESTS FOR HIP PATHOLOGY

TESTS
1. Ortolanis
Sign

Structure/Condition
Being Tested
- To determine
whether an infant
has a CDH

Patient
Position
Supine

*Valid only for first

few weeks after birth
and
only
for
dislocated and lax
hips, not dislocations

Stabilization

Maneuver

(+) Sign

-PTs
thumbs
against the insides
of the knees and
thighs; fingers are
placed along the
outsides of the
thighs to buttocks

- Examiner flexes the

hip and grasps the
legs.
-With gentle traction,
thighs are abducted
and
pressure
is
applied against the
greater trochanters
*Should
not
be
repeated too often
because it could lead
to
damage
of
articular cartilage of
femoral head

2. Barlows Test

- Modification of
Ortolanis Test
- To determine DDH
(developmental
dysplasia of the hip)
- For infants up to 6
months
- Should not be
repeated too often
because it may result
in a dislocated hip or
articular damage to

3PTA Batch 2015

Supine with
legs facing
the
examiner;
hips flexed to
90; knees
are fully
flexed

One
hand:
evaluate hip
Other
hand:
steadies
the
opposite femur and
pelvis
- PTs hand placed
over the greater
trochanter; thumb
is adjacent to the
inner side of the
knee and thigh
opposite the lesser
trochanter

Each
hip
evaluated
individually

is

Part 1. Hip is taken

into abduction while
PTs middle finger
applies
forward
pressure
behind
greater trochanter
Part 2. PT uses
thumb
to
apply
pressure backward
and outward on the
inner thigh

- Resistance to
abduction and
lateral rotation felt
at 30 - 40.
- PT may feel a
click, clunk or jerk
- Femoral head
slips over the
acetabular ridge
into acetabulum
(normal abd = 7090)
*If (-), does not
necessarily rule out
CDH
- Part 1. Femoral
head slips forward
into the acetabulum
with a click, clunk,
jerk
- Part 2. Hip is
unstable is the
femoral head slips
out over the
posterior lip of the
acetabulumand
then reduces again
when pressure is
removed

the head of femur

3. Galeazzi Sign
(Allis or Galleazi
Test)

- good for assessing

unilateral CDH or
DDH

Supine with
knees flexed
and hips
flexed to 90

- One knee is
higher then the
other

- used in children
from 3-18 months

4. Telescoping
Sign
(Piston or
Dupuytrens
Test)

- evident in children
with dislocated hip

Supine

PT flexes knee and

hip to 90; femur is
pushed down onto
the table; femur and
leg are then lifted up
and away from the
table

- Excessive
movements called
Telescoping or
Pistoning

5. Abduction
Test (Harts
Sign)

Congenital
dislocation of hip or
developmental
dysplasia (Evident
when one leg does
not abduct as far as
the other when
changing the childs
diaper)

Supine

Patients hip and

knees flexed to
90 deg
Examiner
passively abducts
both legs

Asymmetry or
limitation of
movement
IF one hip is
dislocated, child
often shows
asymmetry of fat
folds in gluteal
and upper leg
area because of
riding up of
femur on
affected side

TEST FOR LEG LENGTH

TESTS
WeberBarstow
maneuver

Structure/Condition
being tested
Leg length discrepancy

3PTA Batch 2015

Patient
Position
Supine

Stabilization

Maneuver
Patient hips and
knees flexed
examiner stands at
pts feet and
palpates distal
aspect of medial
malleoli with his/her
thumbs
pt. then lifts pelvis
from examining
table and returns to
starting position
Examiner passively
extends patients
legs and compares
positions of malleoli
using borders of
thumbs

(+) Sign
Different level of malleoli
that indicate asymmetry

TEST FOR MUSCLE TIGHTNESS OR PATHOLOGY

Structure/Condition
Patient
TESTS
being tested
Position
Sign of the
Ischial Bursitis,
Supine
Buttock
Neoplasm, abscess in
the buttock, hip
pathology

Thomas Test

Hip flexion contracture

(Most common
contracture of hip)

Supine

Rectus
Femoris
Contracture
Test (Kendall
Test Method
1)

Name is indicative of
condition being tested

Supine

3PTA Batch 2015

Stabilization

Examiner
checks for
excessive
lordosis,
usually
present with
tight hip
flexors

Maneuver

(+) Sign

pt. performs a
straight leg raising
test.
If there is limitation
of SLR, examiner
flexes pts knee to
see whether further
hip flexion can be
obtained

If hip flexion does not

increase, lesion is in
buttock or hip, not
sciatic nerve or
hamstrings
There may also be
limited trunk flexion

Examiner flexes
one of the patients
hips, bringing knee
to chest to flatten
out lumbar spine
and stabilize pelvis
Pt. holds the flexed
hip against the
chest

If no contracture, the
hip being tested(the
one which is straight
on the mat) will remain
flat on the mat
If contracture present :
= pts straight lef rises off
table
= muscle end feel will be
felt
If lower limb is pushed
down onto the table, pt.
may exhibit increased
lordosis, thus it is also
a + sign
When pt flexes knee
and other leg abducts
instead of lifting off the
mat, this is called a J
sign or stroke and is
indicative of a tight ITB
on the straightened leg
If knee extends and
angle increases, there
is probable presence of
contracture
If no palpable
tightness, probable
cause is tight joint
structures and end feel
will be different

In starting position,
pt knees are bent
over the edge of
examining table
Pt then flexes one
knee to chest and
holds it
Angle of knee that
is still hanging at
the edge of the
table should be at
90deg when
opposite knee is
flexed to chest
Examiner may
attempt to
passively flex the
dangling knee to
see if it is able to
remain at 90deg on
its own
Examiner should
ALWAYS palpate
for muscle
tightness when
doing any
contracture test

Elys Test
(Tight Rectus
Femoris,
Method 2)
Obers Test

Tensor Fascia Latae

AKA ITB

TESTS
Noble
Compression
Test

Adduction
Contracture Test

Abduction
Contracture Test

Prone

Examiner passively
flexes pts knee

On flexion of the knee

done by examiner, the
ipsilateral hip also flexes,
there is a tightness of the
Rectus Femoris

Side-lying

Pts lower leg is

flexed at hip and
knee for stability
Examiner passively
abducts and
extends pts upper
leg with knee
straight or flexed at
90deg.

Examiner slowly lowers

leg, and if leg remains
abducted, the test is
positive for a
contracture of ITB
*When doing this test,
extend hip slightly so that
ITB passes over greater
trochanter of femur
If neurological signs
are elicited, examiner
should consider
pathology of femoral
nerve
Tenderness over
greater trochanter,
examiner must
consider trochanteric
bursitis

Structure/Condition
Being Tested
ITB
Friction
Syndrome

Patient
Position
Supine

Adductor
Muscles
Contracture

Supine

Abductor
Muscles
Contracture

Supine

Stabilization

Maneuver

(+) Sign

One Hand:
Thumb
applying
pressure
1-2cm
proximal to the
lateral
femoral
epicondyle

Patient slowly extends

knee up to 30 flexion
while PT maintains
pressure

Pt feels pain over

lateral
femoral
condyle

PT attempts to balance
the lower limb with the
pelvis by shifting the
pelvis up on the
affected side or down
on the unaffected side

Contraction if : the
affected leg forms
an angle of less
than 90 with the
line joining the two
ASISs.

PT attempts to balance
the lower limb with the
pelvis by shifting the
pelvis up on the
affected side or down
on the unaffected side

Functional
shortening
if:
ASIS
moves
before 30-50 of
abduction and the
end feel is tight
Contraction if: the
affected leg forms
an angle of more
than 90 with the
line joining the two
ASISs.
Functional
Lengthening: if the
ASIS
moves
before 30 of hip
adduction

3PTA Batch 2015

Piriformis Test

Piriformis Syndrome

90-90 SLR

Hamstrings
Contracture

90-90 SLR
(Gluteus
Maximus Length)

Gluteus
Tightness

90-90 SLR ( Gluts

Max Strength)

Sidelying

Supine

Maximus

Gluteus
Maximus
Weakness

Supine

Prone

One hand:
On the hip

Pt flexes test hip to

60, knee flexed. The
PT applies downward
pressure to the knee

Pt feels pain in the

buttock, sciatica
may
also
be
experienced

(1)Both hips are flexed

to 90 with knees bent.
(2) Pt actively extends
knee

Unable to extend
the knee within
20 full extension

PT flexes the hip with

knee flexed

ASIS
moves
before the thigh
reaches the trunk

From straight hip and

90 knee flexion, the
patient is asked to
extend the hip keeping
the knee flexed. An
anterior force is applied
by the PT to the
posterior thigh

Pt attempts to
further flex the
knee

Stabilization

Maneuver

(+) Sign

Pts one knee

flexed
against
chest to stabilize
pelvis and the
other
knee
extended

Pt attempts to flex the

trunk and touch the
toes of the extended
lower limb with the
fingers

Pt is unable to
touch toes (tight
hamstrings on the
straight leg)

PT passively extends
one knee

Extension of the
spine

PT flexes the hip and

knee of the test leg
maximally. The PT
then slowly extends the
knee
Pt is asked to remove
the
shoe
on
the
affected side with the
help of the shoe on the
opposite
side
by
putting the heel of the
affected side into the
medial
longitudinal
arch of the stance
(good) leg to pry the
shoe off.

Pain
in
the
hamstrings at the
ischial origin

Other hand:
Apply downward
pressure to the
knee
Patient
grasps
behind the knees
with both hands to
stabilize hips at
90 flexion.
One hand:
ASIS on the same
side
Other hand:
Knee of same side
One hand:
Hip
Other hand:
Posterior
thight,
applying anterior
force

Structure/Condition
Being Tested
Muscle tightness or
pathology

Patient
Position
Sitting

2. Tripod Sign
(Hamstrings
Contracture,
Method 3)

Muscle tightness or
pathology

3. Bent-Knee
Stretch Test for
Proximal
Hamstrings

Muscle tightness or
pathology

Sitting (Pts
both knees
are flexed to
o
90 over the
edge of the
examining
table)
Supine

4. Taking Off the

Shoe (TOST)
Test

Muscle tightness or
pathology

TESTS
1. Hamstrings
Contracture Test
(Method 2)

3PTA Batch 2015

Standing
(affected hip
is
laterally
rotated
o
about
90
o
with 20 to
o
25 flexion at
the knee)

Sharp pain in the

o
biceps femoris (1
o
or
2
muscle
strain)

5, Phelps Test

Muscle tightness or
pathology

Prone with
knees
extended

6. Tightness of
Hip Rotators

Muscle tightness or
pathology

Supine (hip
and
knee
flexed
to
o
90 )

The
PT
passively
abducts both of the pts
legs as far as possible.
The knee are then
o
flexed to 90 and the
PT tries to abduct the
hips further
For tightness of lateral
rotators: The pt is
asked
to
medially
rotate the hip by
rotating
the
leg
outward.
For tightness of medial
rotators:
The pt is
asked to laterally rotate
the hip by rotating the
leg inward.

Abduction
increases
(contracture of the
gracilis muscle)

Lateral
rotators:
medial rotation is
o
less than 30 to
o
40 and end feel
will be muscle
stretch rather than
tissue (capsular)
stretch.
Medial
rotators:
lateral rotation is
o
less than 40 to
o
60 and the end
feel will be muscle
stretch rather than
tissue (capsular)
stretch.

Tests
Lateral Step
Down
Maneuver
(Pelvis
Drop Test)

Fulcrum
Test of the
Hip

Structure or
Condition
Being Tested
Hip rotators
(lateral)

Femoral shaft

Patient
Position

Stabilization

Standing
N/A
One foot on
an 8 inch
stool, arms
on the side
and erect
trunk, no hip
adduction or
IR
Sitting
dangling

N/A

Maneuver

(+) Sign

Pt in initial position is
asked to slowly lower non
weight bearing leg to the
floor

Arms abducted, trunk

inclines forward, weight
bearing hip adducts or IR;
pelvis flex forward or
rotates backward

PTs arm under the pts

thigh moves from distal to
proximal as a gentle
pressure is applied on the
dorsal knee

Sharp pain and

apprehension when the
fulcrum arm is under the
fracture site

ANKLE AND FOOT SPECIAL TESTS

Tests
Neutral
Position of the
Talus
(Standing)

Structure/Condition
Being Tested
Tests for Neutral
Position of the Talus

3PTA Batch 2015

Patient
Position
Standing

Stabilization
One hand:
Palpates Talus on
Dorsum

Maneuver
Pt. rotate trunk from
right to left, causing tibia
to medially and lat.
rotate so talus supinates
and pronates.
If Talus doesnt bulge
on either side=subtalar
is neutral

(+) Sign

Navicular
Drop Test
-a progression
of the Neutral
Position
of
Talus
(Standing)

Tests for Neutral

Position of the Talus

Neutral
Position of the
Talus (Supine)

Tests for Neutral

Position of the Talus

Supine;
feet over
the end of
table

Neutral
Position of the
Talus (Prone)

Tests for Neutral

Position of the Talus

Prone;
foot
extend
over table

Test
Leg
Heel
Alignment

Forefoot
Heel
Alignment

Standing

Palpate the Talus on

Dorsum

Measure
Height
of
navicular from floor in
relaxed standing, and
also in the neutral talus
position

One hand:
th
Grasp foot on 4
th
and 5 Metatarsals
(using thumb and
index)
Other hand:
Palpate both sides
of head of talus on
dorsum
(using
thumb and index)
One hand:
th
th
Grasp 4 and 5
metatarsal
heads
(using index and
thumb)
Other hand:
Palpate both sides
of head of talus on
dorsum
(using
thumb and index)

Passively dorsiflex foot

until resistance is felt.
Then while maintaining
dorsiflexion,
perform
supination,
then
pronation.
Position where the Talar
head
doesnt
bulge=neutral position

Neutral
Talus
Position

Structure/
Condition
Being Tested
Tests
for
Alignment
(valgus or varus
of the foot)

Patient
Position
Prone with
foot
extending
over
the
end of table

Tests
for
Alignment
(valgus or varus
of the foot)

Supine with
feet
extending
over
the
end of table

Coleman
Block Test
- Differentiates
between
hindfoot varus
resulting from
forefoot valgus
and
hindfoot
varus resulting
from a tight
tibialis
posterior

Tests
for
Alignment
(valgus or varus
of the foot)

Standing

3PTA Batch 2015

Difference between
neutral talus height
and normal relaxed
standing. If >10,
Abn.

Passively dorsiflex foot

until resistance is felt.
Then while maintaining
dorsiflexion, move foot
back and forth through
an arc of supination and
pronation. Where the
foot appears to fall off,
that is the neutral
position.

Stabilization

Maneuver

(+) Sign

PT
makes
a
calcaneal
line
(between midline of
calcaneus and 1 cm
distal to first mark),
and
tibial
line
(between two marks
on lower third of leg
in
midline).
PT
places subtalar joint
in
prone
neutral
position.
PT positions subtalar
joint in supine neutral
position

PT places subtalar joint in

prone neutral position.
PT looks at 2 lines.

Hindfoot varus heel

is inverted
Hindfoot valgus heel
is everted
o

(N) 2 to 8 varus

PT pronates midtarsal
joints
maximally,
observes
relation
between vertical axis of
nd
th
heel and plane of 2 - 4
metatarsal heads
If pt is found to have
hindfoot
varus
in
standing, PT places a lift
or block under lateral side
of foot

Forefoot
varus

medial side of foot is

raised
Forefoot
valgus

lateral side of foot is

raised
Tight tibialis posterior
(N) if hindfoot varus is
corrected, hindfoot is
flexible and hindfoot
varus is due to a
plantar flexed first ray
or valgus forefoot

Tibial Torsion
in Sitting

Structure/Condition
Being Tested
Test
for
Tibial
Torsion

Patient
Position
Sitting,
knees
o
flexed 90
over
the
edge of the
table

Tibial Torsion
in Supine

Test
for
Torsion

Tibial Torsion
in Prone

Too
Many
Toes Sign

Test

Stabilization

Maneuver

(+) Sign

Thumb:
Over apex of one
malleolus
Index finger:
Over apex of the
other malleolus

PT visualizes axes of
knee and ankle

(N) not normally

parallel; form an
o
o
angle of 12 -18

Supine

PT ensures femoral
condyle lies in the
frontal plane (patella
facing straight up)

Angle formed by the

intersection of the 2
lines
indicates
amount of lateral
tibial torsion.

Excessive Toeing-in
or toeing-out position
(normal is 13-18);
Tibial Torsion

Prone with
knee
flexed
to
90

No
stabilization
required

Excessive Toe-out
position
(tibial
torsion
is
>18);
Tibial Torsion

Standing

No
stabilization
required

PT palpates apex of
both malleoli with one
hand and draws a line
on the heel representing
a line joining the 2
apices. Another line is
drawn on heel parallel
to floor.
PT views from above
the angle formed by foot
and thigh noting the
angle the foot makes
with the tibia
PT stands behind pt and
examines the foot from
a posterior view

Test
Anterior Drawer
Test

Tibial

Structure/
Condition Being
Tested
Anterior talofibular
ligament instability

Stabilization

Maneuver

(+) Sign

Supine with foot

relaxed

One hand: grasps

tibia and fubula

Draws the talus

forward
in
the
ankle mortise

Excessive
anterior
translation
Due
to
torn
medial
and
lateral ligaments
Excessive
anterior
movement and a
sucking in of
Achilles tendon
skin
Excessive
abduction
or
adduction

Anterior talofibular
ligament Instability

Prone with feet

extending over the
end of table

Talar Tilt

Test
for
torn
Calcaneofibular
ligament

Supine or sidelying
with foot relaxed

Squeeze
Test
for the Leg
(Distal
Tibiofibular
Compression
Test)

3PTA Batch 2015

Structure/Condition
Being Tested
Syndesmosis Injury

Heel is in valgus,
forefoot abducted, or
if tibia is laterally
rotated more than
normal

Patient Position

Prone Anterior
Drawer Test

Test

Excssive toeing-in or
toeing-out

Patient
Position
Supine

Other hand: holds

foot of pt in 20
plantar flexion
One hand:
Grasps the ankle

One hand:
PT holds affected
foot in anatomical
(90) position

Stabilization
Examiner grasps
the lower leg at
midcalf

PT uses other
hand to push heel
steadily forward

PT uses other
hand to tilt talus of
affected foot, side
to
side
into
adduction
and
abduction

Maneuver
Examiner
squeezes tibia and
fibula
together.
Apply
at
more
distal
locations
toward the ankle.

(+) Sign
Pain in
Lower Leg

the

10

External
Rotation Stress
Test
(Kleiger Test)

Syndesmosis Injury

Sitting with legs

hanging
over
table

Stabilizes leg with

one hand. The
other hand holds
the foot in neutral
(platigrade
90)
position

Point Palpation
Test

Syndesmosis injury

Sitting or Supine

Cotton Test

Syndesmosis instability
with
diastasis
(separation of the tibia
and fibula)

Sitting

Stabilize
distal
tibia with one
hand

Sits on edge of
table

Stabilize patient
leg with one hand

Syndesmosis Injury

Sitting
with
affected
leg
crossed over the
opposite knee

Examiner grasps
the lower leg at
midcalf

Syndesmosis Injury

Bilateral
bearing

Dorsiflexion
Maneuver

Crossed
Test

Leg

Dorsiflexion
Compression
Test

weight

Compression over
the malleoli rather
than shaft of tibia
and fibula
Passive
lateral
rotation stress to
the foot and ankle

Examiner applies
gradual
pressure
over
the
anteroinferior
tibiofibular ligament
(anterior aspect of
the
distal
tibia
fibular
syndesmosis)
using the index
finger
Apply medial and
lateral translation
force with the other
hand
(not
inversion/eversion)
Passively
and
forcefully dorsiflex
the foot by holding
onto the heel using
the
forearm
to
dorsiflex the foot

Syndesmosis
Injury = Pain
produced over
the anterior or
posterior
tibiofibular
ligaments and
the
interosseous
membrane
Deltoid
Ligament Injury
= pain medially
and the talus
displaces from
the
medial
malleolus
Pain in the
syndesmosis
area

Any
lateral
translation
>3-5mm
Clunk
Pain on forced
dorsiflexion

Gentle force to the

medial aspect of
the knee of the
injured leg

Pain in the area

of the distal
syndesmosis

Patient is asked to
move his or her
ankle into extreme
dorsiflexion (Pt. is
asked
to
note
whether
this
maneuver is painful
while PT notes
ROM)

A decrease
pain
dorsiflexion
an increase
dorsiflexion
range

in
on
or
in

Pt. the assumes a

3PTA Batch 2015

11

Heel
Test

Thump

Test
Functional Leg
Length

Syndesmosis injury

Structure/
Condition Being
Tested
Other Tests/ Tests
for
Muscle
or
Tendon Affectation

Sitting or Supine

Patient Position

One
hand
to
stabilize the leg

Stabilization

Patient stands on a
normal
relaxed
stance

normal
standing
position. PT applies
a
compression
force using two
hands surrounding
the
malleoli
of
injured leg. Pt. is
asked to dorsiflex
when compression
is maintained
Other hand, PT
applies
a
firm
thump on the heel
with the fist so that
the force is applied
to the center of the
heel and in line
with the long axis
on the tiba

Syndesmosis
Injury: Pain in
area of the
ankle
Stress
Fracture: Pain
along the shaft
of tibia

Maneuver

(+) Sign

PT
palpates
the
ASIS and PSIS .
PT then positions the
patients
subtalar
joint
in
neutral
position while weight
bearing
PT. maintains this
position with the toes
straight ahead and
knees straight
PT repalpates the
ASIS and PSIS
problems

If the previously
noted
differences
remain,
the
pelvis
and
sacroiliac joints
should
be
evaluated
further. If they
disappeared,
the PT should
suspect
a
functional
leg
length difference
(hip/knee/ankle/f
oot)
Determine what
causes
the
difference

Thompsons
(Simmonds)
Test (Sign for
Achilles
Tendon
Rupture

3PTA Batch 2015

Other Tests/ Tests

for
Muscle
or
Tendon Affectation

Prone/Kneeling on a
chair with feet over
the edge of the table
or chair

N/A

PT squeezes
muslces

calf

Foot Pronation
seen
w/
forefoot/hindofo
ot varus, tibial
varus,
tight
muscles (Calf /
Hamstrings/ Hip
Flexors or weak
muscles
(Piriformis
/
Ankle Invertors)
Absence
of
plantar flexion

12

Firgure-8 Ankle
Measurement
for Swelling

Other Tests/ Tests

for
Muscle
or
Tendon Affectation

Long sitting with

ankle and lower leg
beyond the edge of
the table; ankle in
PLANTIGRADE
o
(90 )

N/A

Test
for
Peroneal
Tendon
Dislocation

Other Tests/ Tests

for
Muscle
or
Tendon Affectation

Prone with
o
flexed to 90

knee

N/A

Swing Test for

Posterior
Tibiotalar
Sublaxation

Other Tests/ Tests

for
Muscle
or
Tendon Affectation

Prone with
o
flexed to 90

knee

One hand:
Calcaneus held in
eversion
and
ankle
in
dorsiflexion

PT places end of
tape
measure
midway between the
tibialis
anterior
tendon
and
the
lateral
malleolus,
draws tape medially
across instep just
distal to the navicular
tuberosity, tape is
then pulled across
the arch of the foot
just proximal to the
base of the fifth
metatarsal,
across
the tibialis anterior
tendon and then
around the ankle
joint just distal to the
tip of the medial
malleolus across the
Achilles tendon and
just distal to the
lateral
malleolus
returning
to
the
starting point.
Posterolateral region
of ankle is inspected
for swelling. Pt asked
to
dorsiflex
and
plantarflex
woth
eversion
against
PTs resistance.
Push dorsally on the
navicular
and
metatarsal heads

Done 3x
averaged.

then

Tendon
sublaxes form
behind
lateral
malleolus.

Reproduction of
Pts symptoms.

Other hand:
Thumb contacts
the
plantar
surface of the
nd
base of the 2 ,
rd
th
3 ,
4
metatarsals with
index finger and
middle
finger
contact
planter
surface
of
navicular.

Test
Feiss Line

Structure/Condition
Being Tested
Medial longitudinal
arch

Patient Position

Stabilization

Initial: non weight

bearing on legs

Instruct patient
stand straight

Later: stands with

feet 8-15 cm (3 to
6 in) apart

3PTA Batch 2015

to

Maneuver

(+) Sign

Initial: mark apex

of medial malleolus
and plantar aspect
of first metatarsal;
mark
navicular
tuberosity
on
medial foot

If
navicular
tuberosity mark
falls
1/3
distance
towards
floor
(FIRST
DEGREE
FLATFOOT);

13

Later: observe that

all
points
are
aligned

Hoffas Test

Calcaneal fracture

Prone,
feet
extended
over
edge of table

Prevent knee flexion

Palpate
Achilles
tendon while pt
plantar
and
dorsiflexes

Tinels Sign at
the
Ankle
(Percussion
Sign)

Nerve affectation

Stabilize leg

a.) tap at front of

ankle

Duchenne Test

Nerve affectation

Supine
*may be elicited
in two places
a.) Anterior Tibial
Branch of Deep
Peroneal Nerve
b.)
Posterior
Tibial Nerve
Supine,
legs
straight

Prevent knee flexion

Push up on head
of first metatarsal
through the sole
(towards
dorsiflexion)

Mortons Test

Fracture or
affectation

Supine

Stabilize distal leg

Homans Sign

Deep
thrombosis

Grasp foot about

metatarsal heads,
squeeze
heads
together
Passive
dorsiflexion

3PTA Batch 2015

nerve

venous

Supine,
extended

knee

b.) tap at posterior

part
of
medial
malleolus

N/A

If it falls 2/3
distance
towards
the
floor (SECOND
DEGREE
FLATFOOT)
If it rests on the
floor
(THIRD
DEGREE
FLATFOOT)
Positive
for
calcaneal
fracture
if
injured side is
less taut than
the other
Positive if there
is tingling or
paresthesia felt
distally (applies
to both)

Positive
for
lesion
of
superficial
peroneal nerve
or L4, L5, or S1
nerve = when
patient is asked
to
plantarflex,
medial border of
foot dorsiflexes
(no resistance
by patient) but
lateral border of
foot
plantarflexes
Positive
for
stress fracture
or neuroma if
there is pain
Positive
for
deep
vein
thrombophlebitis
if
there
is
pain/tenderness
at calf; positive
also if pallor and
swelling at leg,
loss of dorsalis
pedis pulse are
present

14