The Prone Anterior Drawer Test assesses anterior translation of the talus while the client lies prone. It is commonly used to help assess anterior talofibular ligament involvement after lateral ankle sprain or in chronic ankle instability. A 2022 systematic review found that physical examination tests for ankle instability vary in reliability and validity, so manual anterior drawer findings should be interpreted with injury history, swelling, palpation, comparison side and function rather than used alone.
A client reports rolling their ankle during sport, landing from a jump or stepping awkwardly on uneven ground. They may describe lateral ankle pain, swelling, reduced confidence or repeated giving way. The standard anterior drawer test may be performed in sitting or supine, but a prone position can sometimes make it easier to stabilise the lower leg and assess talar translation.
The Prone Anterior Drawer Test can support lateral ankle ligament assessment, but it should not be treated as a stand-alone diagnosis of ATFL tear. Pain, guarding, swelling and natural side-to-side laxity can all influence the result.
Test name: Prone Anterior Drawer Test
Body region: Lateral ankle, talocrural joint, anterior talofibular ligament
Purpose: Assess anterior talar translation and endpoint quality
Positive finding: Increased anterior translation, soft endpoint, apprehension or familiar instability compared with the other side
Negative finding: No meaningful side-to-side difference, firm endpoint and no familiar instability response
Best used with: Standard ankle anterior drawer, talar tilt, palpation, ankle ROM, swelling, balance testing and hop/function testing
Key limitation: It does not confirm ATFL tear or injury grade on its own
The Prone Anterior Drawer Test is a variation of the ankle anterior drawer test. The client lies prone while the professional stabilises the lower leg and applies an anterior translation force to the talus and rearfoot.
The aim is to assess anterior talar movement, endpoint quality and symptom response compared with the opposite side.
The test is used when lateral ankle ligament injury or chronic ankle instability is part of the assessment reasoning.
It may be useful after inversion ankle sprain, repeated ankle rolling, giving-way symptoms, cutting or jumping injuries, or when the client reports instability on uneven ground.
The test assesses anterior talar translation and endpoint quality. It does not directly visualise the ATFL and does not confirm whether a ligament is sprained, partially torn or fully torn.
Pain during the test may reflect acute sprain, swelling, synovitis, guarding, joint irritation or other lateral ankle structures.
This test may be useful for field-sport athletes, court-sport athletes, runners, dancers, hikers, gym clients and anyone with lateral ankle sprain history or giving-way symptoms.
Use when lateral ankle instability is relevant and the ankle can tolerate gentle stress testing.
In acute injury, consider fracture risk, swelling and irritability before applying ligament stress.
Use caution with suspected fracture, severe swelling, inability to weight bear, severe pain, recent surgery, obvious deformity, high irritability or neurological symptoms.
Do not force the test if pain or guarding prevents useful interpretation.
Treatment table
Pain scale
Measurz recording workflow
Optional swelling notes
Optional comparison-side notes
Position the client prone with the foot hanging comfortably over the end of the table.
The knee is relaxed. The ankle is usually held in slight plantarflexion depending on the selected protocol.
Stand at the foot end of the table.
Stabilise the distal tibia and fibula with one hand. Cup the calcaneus and rearfoot with the other hand.
Keep the lower leg still and avoid rotating the limb.
Apply a gentle anterior translation force to the talus and rearfoot relative to the tibia and fibula.
Ask the client to report pain, apprehension, instability sensation, symptom location and whether the sensation is familiar.
A positive finding is increased anterior translation, a soft or absent endpoint, apprehension or familiar instability compared with the other side.
A negative finding is no meaningful side-to-side difference, firm endpoint and no familiar instability response.
Stop if pain increases sharply, guarding prevents assessment, instability feels excessive or symptoms are not tolerated.
Compare sides and record pain, translation and endpoint separately.
A positive Prone Anterior Drawer Test may increase suspicion of ATFL involvement or mechanical ankle instability when there is increased anterior translation and a softer endpoint compared with the other side.
Pain alone is not the same as laxity. Acute swelling or guarding may reduce translation and create a false-negative result, while natural ligament laxity may create apparent movement without symptoms.
A negative test reduces suspicion of anterior talar laxity in the tested position, but it does not exclude lateral ankle sprain, especially in acute, painful or guarded presentations.
High-quality diagnostic accuracy values for the prone variation alone are limited. Evidence for ankle anterior drawer testing more broadly suggests that manual examination tests for ankle instability vary in reliability and validity, and no single test has robust reliability and validity across all included studies.
Condition or presentation: lateral ankle sprain, ATFL involvement or chronic ankle instability
Population: people with suspected ankle sprain or instability
Test variation: prone anterior drawer variation of manual anterior drawer testing
Reference standard: variable across studies, including imaging, stress radiography and clinical criteria
Sensitivity: not clearly established for the prone variation alone
Specificity: not clearly established for the prone variation alone
Positive likelihood ratio: not available for the prone variation alone
Negative likelihood ratio: not available for the prone variation alone
Key limitations: variable ankle position, examiner force, acute swelling, guarding, side-to-side laxity differences and limited prone-specific validation
A systematic review of ligamentous ankle injury tests also noted that clinical assessment of suspected lateral ligament injury commonly relies on palpation and manual stress tests such as anterior drawer and talar tilt, but diagnostic accuracy evidence is limited by study methods and reference standards.
Reliability depends on ankle angle, client relaxation, hand placement, applied force, examiner experience, comparison side and how endpoint quality is defined.
Validity improves when the test is interpreted with injury mechanism, swelling, palpation, talar tilt, balance, hop testing and return-to-sport function.
Common errors include testing too aggressively, not comparing sides, mistaking pain for laxity, failing to record endpoint quality and ignoring fracture risk in acute trauma.
Limitations include guarding, swelling, pain sensitivity, natural laxity, examiner force variation and limited prone-specific diagnostic evidence.
Use the Prone Anterior Drawer Test to document anterior talar translation and instability symptoms. It can support return-to-run planning, balance progression, bracing decisions and referral reasoning when instability is marked.
Record test name, side tested, result, pain score, symptom location, prone position, ankle angle, force direction, translation grade if used, endpoint quality, apprehension, swelling, comparison side, confidence in result and reason for stopping.
Add related findings such as standard anterior drawer, talar tilt, ankle ROM, palpation tenderness, balance testing, hop testing, prior sprain history and return-to-sport notes.
Anterior Drawer of the Ankle
Talar Tilt Test
Eversion Stress Test
Kleiger’s Test
Squeeze Test
Ankle Dorsiflexion Test
Single Leg Calf Raise
Balance and Proprioception Tests
It assesses anterior talar translation and endpoint quality, commonly related to ATFL involvement.
A positive result may include increased anterior movement, a soft endpoint, apprehension or familiar instability compared with the other side.
No. It may support suspicion but does not confirm a tear or injury grade on its own.
The prone position may help some professionals stabilise the limb and assess talar translation more comfortably.
Record side, pain, ankle position, translation, endpoint, apprehension, swelling and comparison side.
The Prone Anterior Drawer Test is a variation of ankle anterior drawer testing.
A positive finding should include laxity or endpoint change, not pain alone.
Prone-specific diagnostic accuracy evidence is limited.
Use it with talar tilt, history, swelling and functional testing.
Measurz should capture position, pain, translation, endpoint and comparison findings.
Beynon, A. M., Le May, S., & Théroux, J. (2022). Reliability and validity of physical examination tests for the assessment of ankle instability. Chiropractic & Manual Therapies, 30, 58.
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.
