The Eversion Stress Test is used to assess medial ankle structures, particularly the deltoid ligament complex, by applying an eversion stress to the ankle. A positive finding may include medial ankle pain, increased eversion laxity or apprehension compared with the other side. Evidence for diagnostic accuracy is limited, so the result should be interpreted with history, mechanism, palpation, swelling, imaging where relevant and other ankle tests.
A client may report medial ankle pain after an eversion or rotational ankle injury. The Eversion Stress Test can help assess whether medial ankle structures may be sensitive or lax under eversion loading.
Medial ankle ligament injuries are less common than lateral ankle sprains and may occur with rotational injuries, syndesmosis involvement or more complex ankle trauma. Because diagnostic evidence for the exact clinical test is limited, the Eversion Stress Test should support, not replace, broader assessment.The Eversion Stress Test assesses medial ankle pain, laxity or apprehension when an eversion force is applied to the ankle. It is commonly used when deltoid ligament involvement or medial ankle sprain is suspected. Current ankle ligament test evidence is stronger for lateral ligament and syndesmosis tests than for the eversion stress test alone, so interpretation should be cautious and combined with injury mechanism, medial tenderness, swelling, weight-bearing ability and referral reasoning.
A client reports medial ankle pain after landing awkwardly, being tackled, twisting the ankle outward or sustaining a high-energy ankle injury. Medial swelling or tenderness may raise concern for deltoid ligament involvement, syndesmosis injury or fracture.
The Eversion Stress Test can help assess whether medial ankle loading reproduces familiar symptoms or reveals excessive laxity. It should be performed gently and interpreted with the full injury picture.
Test name: Eversion Stress Test
Body region: Medial ankle, deltoid ligament complex
Purpose: Assess medial ankle pain, laxity and endpoint quality under eversion load
Positive finding: Familiar medial ankle pain, apprehension, increased eversion laxity or soft endpoint compared with the other side
Negative finding: No familiar pain, apprehension or meaningful side-to-side laxity
Best used with: Medial palpation, ankle ROM, squeeze test, Kleiger’s test, fracture screening, swelling and weight-bearing assessment
Key limitation: Stand-alone diagnostic accuracy evidence for this test appears limited
The Eversion Stress Test is a manual ankle stress test. The professional stabilises the lower leg and applies an eversion force to the foot and ankle, stressing medial ankle structures.
It is often considered when deltoid ligament involvement or medial ankle instability is suspected.
The test is used to assess symptom response and laxity under medial ankle stress. It may be relevant after eversion injuries, high ankle sprain mechanisms, contact injuries, falls or twisting trauma.
The test assesses medial ankle pain, eversion laxity and endpoint quality. It does not directly confirm deltoid ligament injury.
Pain may also arise from medial malleolar fracture, talar injury, posterior tibial tendon symptoms, syndesmosis injury, impingement, joint irritation or swelling.
This test may be useful for athletes, runners, field-sport players, dancers and clients with medial ankle pain after twisting, landing, cutting or contact injury.
Use when medial ankle ligament involvement is clinically relevant and acute fracture or severe injury has been considered.
Use caution with acute trauma, suspected fracture, inability to weight bear, severe swelling, severe pain, obvious deformity, recent surgery or high irritability.
Do not force eversion stress in an acute or unstable presentation.
Treatment table or chair
Pain scale
Measurz recording workflow
Optional comparison-side notes
Optional referral notes
Position the client sitting or supine with the lower leg supported.
The ankle is relaxed, usually close to neutral.
Stand or sit facing the foot.
Stabilise the distal tibia and fibula with one hand. Hold the calcaneus and midfoot with the other.
Keep the lower leg still and avoid hip or knee compensation.
Apply a gradual eversion force to the foot and ankle.
Ask the client to report medial ankle pain, apprehension, instability, symptom location and whether symptoms are familiar.
A positive finding is familiar medial ankle pain, apprehension, increased eversion laxity or soft endpoint compared with the other side.
A negative finding is no familiar medial ankle pain, apprehension or meaningful side-to-side laxity.
Stop if pain increases sharply, instability is obvious, guarding dominates or symptoms are not tolerated.
Record pain, laxity and endpoint separately.
A positive Eversion Stress Test may increase suspicion of deltoid ligament involvement when medial pain, swelling, tenderness and mechanism of injury align. Increased laxity or a soft endpoint compared with the other side may raise concern for more significant ligament involvement.
A positive test does not confirm deltoid ligament injury or exclude other causes of medial ankle pain. Medial malleolar fracture, talar injury and syndesmosis injury should be considered when the mechanism or symptoms are concerning.
A negative test reduces suspicion of medial laxity under the tested conditions, but it does not fully exclude deltoid ligament injury, especially in acute guarded presentations.
High-quality 2020+ diagnostic accuracy evidence for the Eversion Stress Test as a stand-alone test appears limited.
Condition or presentation: suspected deltoid ligament injury or medial ankle sprain
Population: not clearly established for this exact test alone
Test variation: manual eversion stress applied to the ankle
Reference standard: not consistently established
Sensitivity: not available
Specificity: not available
Positive likelihood ratio: not available
Negative likelihood ratio: not available
Key limitations: limited validation, overlap with fracture/syndesmosis injuries, examiner-dependent force and variable test position
A 2022 systematic review of ankle ligament clinical tests focused on talocrural and subtalar ligament injury after ankle sprain and found that diagnostic accuracy varies by test and reference standard; this supports cautious interpretation of individual manual tests.
Reliability depends on ankle position, force level, stabilisation, comparison side and how pain, laxity and endpoint are defined.
Validity is strongest when the Eversion Stress Test is interpreted with mechanism of injury, medial tenderness, swelling, weight-bearing ability and related syndesmosis/fracture screening.
Common errors include forcing eversion after acute trauma, failing to compare sides, interpreting pain as laxity, ignoring syndesmosis injury and not recording endpoint quality.
Limitations include pain guarding, swelling, examiner force variation, low stand-alone validation and symptom overlap with other medial ankle conditions.
Use the Eversion Stress Test to document medial ankle response to eversion stress and guide referral, load modification and further testing decisions.
Record test name, side tested, result, pain score, symptom location, ankle position, force direction, laxity, endpoint quality, apprehension, swelling, comparison side, confidence in result and reason for stopping.
Add related findings such as medial palpation, Kleiger’s Test, Squeeze Test, ankle ROM, weight-bearing ability, swelling and referral notes.
Kleiger’s Test
Squeeze Test
Talar Tilt Test
Anterior Drawer of the Ankle
Ankle Dorsiflexion Test
Ankle Eversion Test
Balance and Proprioception Tests
Single Leg Calf Raise
It assesses medial ankle pain, laxity and endpoint quality under eversion load.
A positive result may include familiar medial ankle pain, apprehension, increased laxity or a soft endpoint.
No. It may support suspicion but does not confirm a tear on its own.
Medial ankle pain and eversion/external rotation mechanisms can overlap with syndesmosis injury patterns.
Record side, pain score, ankle position, eversion force response, laxity, endpoint and comparison side.
The Eversion Stress Test assesses medial ankle response to eversion load.
Pain, laxity and endpoint should be recorded separately.
It does not confirm deltoid ligament injury on its own.
Consider fracture and syndesmosis injury when the mechanism is concerning.
Measurz should capture symptoms, force direction, endpoint and comparison findings.
Netterström-Wedin, F., & Bleakley, C. (2022). Diagnostic accuracy of clinical tests assessing ligamentous injury of the talocrural and subtalar joints: A systematic review with meta-analysis. Sports Health.
Powden, C. J., Dodds, T. K., & Gabriel, E. H. (2022). Reliability and validity of physical examination tests for the assessment of ankle instability. Chiropractic & Manual Therapies, 30, Article 61.
