Talar Tilt Test

Talar Tilt Test consists of two parts, Inversion Stress Test or Varus Stress Test and Eversion Stress Test or Valgus Stress Test:

• Inversion Stress Test or Varus Stress Test is used to Evaluate the injury to the lateral collateral ligament of the ankle (calcaneofibular, posterior talofibular, and anterior talofibular ligaments).
• While the Eversion Stress Test or Valgus Stress Test is used in Evaluation of an injury to the deltoid ligament, especially the tibio calcaneal part of the ligament.

See Also: Ankle Anatomy

How do you perform the Talar Tilt Test?

The patient lies supine or sits with both legs hanging from the edge of the examination table. The examiner grasps the patient’s calcaneus with one hand and keeps the foot in a neutral position. The other hand stabilizes the lower leg above the ankle:

Inversion Stress Test:

In Inversion Stress Test the thumb or the fingers palpate the calcaneofibular ligament. From this position and maximal dorsiflexion, the examiner inverts the foot at the ankle joint (hindfoot varus stress).

Eversion Stress Test:

In Eversion Stress Test, the thumb (or fingers) placed along the deltoid ligament to note any gapping between the talus and mortise. From this position, the examiner everts the foot (hindfoot valgus stress).

The laxity is compared to the contralateral side.

See Also: Posterior Drawer Test of the Ankle

What does a positive Talar Tilt Test mean?

Visibly or palpably obvious strong angulation or a difference of more than 15° between both ankles associated with pain is suggestive of complete tears of lateral collateral ligament of the ankle or the deltoid ligament.

Talar Tilt Test Accuracy

A Clinical Trial study by A B Rosen for diagnostic accuracy of instrumented and manual talar tilt tests in chronic ankle instability populations, The sensitivity and Specificity was:

Test	Sensitivity	Specificity
Inversion Stress Test (Medial Talar tilt test)	49 %	78 – 88 %
Eversion Stress Test (Lateral Talar tilt test)	36 %	72 – 94 %

Another Systematic review study by Braun Schwieterman found that the sensitivity and specificity of the medial talar tilt stress test was 50% and 88 % respectively.

Notes

• Maximum dorsiflexion locks the subtalar joint and improves the sensitivity of this test.
• The ankle joint and the subtalar joint should be examined individually on both sides, because some individuals (especially children) who are suspected of having joint instability, actually have physiologically lax joints.
• One can obtain a better assessment of this test if it is performed together with the anterior drawer test. The combination of an anterior drawer of > 5 mm and gapping of > 10° on the tilt test is suggestive of injury to the anterior talofibular and calcaneofibular ligaments.
• It is important to differentiate the abnormally exaggerated valgus of the ankle from the exaggerated valgus at the subtalar joint. This is quite common in neurogenic disorders with secondary foot deformations. This is more appreciable when the patient stands weight-bearing, stressing the foot naturally with the examiner standing behind the patient. Observe the level of the malleoli; normally, the lateral malleolus lies about a centimeter beneath the medial malleolus. If the medial malleolus is at a lower level, the valgus is from the ankle.

References

• Rosen AB, Ko J, Brown CN. Diagnostic accuracy of instrumented and manual talar tilt tests in chronic ankle instability populations. Scand J Med Sci Sports. 2015 Apr;25(2):e214-21. doi: 10.1111/sms.12288. Epub 2014 Jul 4. PMID: 24995627.
• Schwieterman B, Haas D, Columber K, Knupp D, Cook C. Diagnostic accuracy of physical examination tests of the ankle/foot complex: a systematic review. Int J Sports Phys Ther. 2013 Aug;8(4):416-26. PMID: 24175128; PMCID: PMC3812842.
• Clinical Tests for the Musculoskeletal System 3rd Edition.
• Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.