Hello Surgeon

X

How can we help you today?

Special Test

Heel Thump Test

Heel Thump Test (or as it called Heel Percussion Test) is a clinical procedure used to evaluate the tibia bone for the presence of stress fracture. It is also used for evaluating ankle injuries to differentiate syndesmotic sprains from lateral ankle sprains.

Heel Thump Test was first described by Lindenfeld & Parikh in 2005.

How it’s Performed?

  • The patient sits at the edge of the examination table with the lower legs hanging down loosely and both feet plantar flexed at the ankle.
  • The examiner holds the patient’s lower leg with one hand, and with the other hand delivers an axillary directed gentle thump to the heel with the fist.
  • Thumping the heel forces the talus to contact the mortise and reproduce the patient’s pain complaint.
See Also: Ankle Anatomy
Heel Thump Test
Heel Thump Test

What does a positive Heel Thump Test mean?

Heel Thump Test is positive if pain is experienced at the distal tibiofibular syndesmosis, this suggests the presence of injury.

Although the heel thump test has been recommended to help differentiate between a syndesmotic injury and a lateral ankle sprain, it is also used for tibial stress fractures.

Sensitivity & Specificity

The diagnostic accuracy of this test is unknown.

Notes

Heel Thump test may have supplemental value if there is enough swelling to decrease the specificity of palpation.

It is also valuable when the injury is too acutely uncomfortable to induce dorsiflexion and/or external rotation stresses.

Related Anatomy

Ankle Ligaments Anatomy

LigamentProximal AttachmentDistal AttachmentFunction
Anterior inferior tibiofibularTibiaFibulaStability of ankle mortise
Interosseous ligamentTibiaFibulaStability of ankle mortise
Posterior inferior tibiofibular ligamentTibiaFibulaStability of ankle mortise
TIBIOFIBULAR (SYNDESMOSIS)
LigamentProximal AttachmentDistal AttachmentFunction
Anterior talofibular Lateral malleolusTransversely to talus anteriorlyLimits inversion in plantar flexion
CalcaneofibularLateral malleolusObliquely to calcaneus posteriorlyLimits inversion in neutral or dorsiflexion
Posterior talofibularLateral malleolusTransversely to talus posteriorlyLimits posterior talar displacement and external rotation
LATERAL ANKLE
LigamentProximal AttachmentDistal AttachmentFunction
Tibionavicular Medial malleolusNavicular tuberosityLimits talar external rotation
TibiocalcanealMedial malleolusSustentaculum taliLimits hindfoot eversion
Anterior tibiotalarMedial malleolusMedial surface of taluLimits lateral displacement of talus, external rotation
Posterior tibiotalarMedial malleolusInner side of talusLimits lateral displacement
MEDIAL ANKLE (DELTOID)

Reference

  1. Edward P. Mulligan. Evaluation and management of ankle syndesmosis injuries. May 2011 Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine 12(2):57-69. Researchgate.
  2. Clinical Tests for the Musculoskeletal system 3rd Edition.
  3. MILLER’S REVIEW OF ORTHOPAEDICS 7th Edition.

Last Reviewed
June 2, 2023
Contributed by
OrthoFixar

Orthofixar does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice.

Angle Meter App for Android & iOS
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase
Orthopedic FRCS VIVAs Quiz
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase
Top 12 Best Free Orthopedic Apps
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase
All-in-one Orthopedic App
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase