Ankle Orthopaedic Test: Anterior Drawer of the Ankle

What this test measures

The anterior drawer test is used to assess anterior talar translation relative to the tibia, primarily to help evaluate the integrity of the anterior talofibular ligament (ATFL). It is most commonly used when a lateral ankle sprain is suspected and should be interpreted alongside the injury history, observation, palpation, and other clinical findings rather than in isolation.

Why test it?

Use this test when you want to assess:

• suspected lateral ankle ligament injury

• possible ATFL involvement

• feelings of ankle instability after an inversion mechanism

• side-to-side differences in perceived anterior laxity

• whether mechanical laxity may be contributing to ongoing symptoms or recurrent sprains

Equipment needed

• treatment table or plinth

• towel or pillow if needed for comfort

• optional marker or note template for documenting pain, end-feel, and side-to-side difference

No special equipment is required for the manual test itself.

Standardised setup

• client lies supine

• knee is flexed to help relax the gastrocnemius

• ankle is placed in a comfortable slight plantarflexion position

• lower leg is stabilised

• test is performed the same way on both sides

• compare the amount of translation, end-feel, and symptom response side to side

Step-by-step procedure

1. Position the client lying on their back on the table.

2. Flex the knee so the lower leg is relaxed.

3. Place the ankle in slight plantarflexion.

4. Stabilise the distal tibia and fibula with one hand.

5. Cup the calcaneus with the other hand.

6. Draw the heel and talus anteriorly while keeping the lower leg fixed.

7. Assess:

   • the amount of anterior movement

   • the quality of the end-feel

   • pain reproduction

   • apprehension or guarding

8. Repeat on the unaffected side using the same setup.

9. Compare the two sides before drawing conclusions.

Common mistakes

• testing with too much muscle guarding

• not stabilising the lower leg properly

• pulling the whole foot instead of controlling the heel/talus

• testing in an inconsistent ankle position

• relying only on pain and ignoring end-feel and side-to-side comparison

• treating the test as diagnostic on its own without using the rest of the clinical examination

How to interpret it

• Increased anterior translation compared with the other side may suggest ATFL laxity.

• A soft or delayed end-feel may also support mechanical laxity.

• Pain alone does not confirm instability.

• In the acute setting, swelling, pain, and guarding can affect the result, so interpretation should stay cautious.

• The anterior drawer test is best used as part of a cluster of findings, not as a standalone diagnosis.

MAT takeaway

The anterior drawer test is useful for assessing possible ATFL-related laxity, but it works best when the setup is standardised and the result is compared side to side. It should support your overall assessment, not replace it.

References

Beynon, A. M., Murphy, D. F., & Allet, L. (2022). Reliability and validity of physical examination tests for the diagnosis of ankle sprains and instability: A systematic review. Physical Therapy in Sport, 58, 190–204. https://pubmed.ncbi.nlm.nih.gov/36536446/

Martin, R. L., Davenport, T. E., Fraser, J. J., Sawdon-Bea, J., Carcia, C. R., Carroll, L. A., Kivlan, B. R., & Carreira, D. (2021). Ankle stability and movement coordination impairments: Lateral ankle ligament sprains revision 2021. Journal of Orthopaedic & Sports Physical Therapy, 51(4), CPG1–CPG80. https://doi.org/10.2519/jospt.2021.0302