The Anterior Drawer of the Ankle assesses anterior translation of the talus relative to the tibia and fibula, commonly to help assess anterior talofibular ligament involvement after lateral ankle sprain. A positive finding may include increased anterior translation, a soft endpoint, apprehension or familiar symptoms compared with the other side. A 2022 systematic review found that physical examination tests for ankle instability show variable reliability and validity, and no single test demonstrated robust reliability and validity across studies.
A client rolls their ankle during sport, stepping off a curb or landing from a jump. They report lateral ankle pain, swelling and a sense that the ankle may “give way”. After fracture risk and acute injury severity have been considered, the Anterior Drawer of the Ankle can help assess whether anterior talar translation is increased compared with the other side.
This test should not be interpreted as a complete diagnosis on its own. Pain, swelling, guarding, injury timing and examiner technique can all influence the result.
Test name: Anterior Drawer of the Ankle
Body region: Lateral ankle, talocrural joint, anterior talofibular ligament
Purpose: Assess anterior talar translation and ATFL-related laxity
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: Ottawa ankle rules reasoning where relevant, palpation, talar tilt, ankle ROM, swelling, function, balance and return-to-sport testing
Key limitation: Pain or guarding can affect the result, and a negative test does not exclude all lateral ankle ligament injury
The Anterior Drawer of the Ankle is a manual ligament stress test. The professional stabilises the lower leg and draws the foot and talus anteriorly to assess anterior translation and endpoint quality.
It is most commonly used when the anterior talofibular ligament is suspected after inversion ankle sprain.
The test is used to assess mechanical laxity and symptom response after lateral ankle injury. It may also be used in chronic ankle instability when a client reports repeated rolling, giving way or lack of confidence during cutting, running, jumping or uneven-ground tasks.
The test assesses anterior talar translation and endpoint quality. It does not directly visualise the ATFL and does not confirm a ligament tear on its own.
Pain during the test may reflect acute sprain, joint irritation, swelling, guarding, synovitis, fracture risk or other lateral ankle structures.
This test may be useful for athletes, gym clients, runners, field-sport players, dancers, hikers and clients with lateral ankle sprain history, giving-way symptoms or suspected chronic ankle instability.
Use when lateral ankle ligament involvement is clinically relevant and the ankle can tolerate gentle stress testing.
In acute injury, consider fracture screening and swelling/irritability before applying stress.
Use caution with acute trauma, suspected fracture, severe swelling, severe pain, inability to weight bear, recent surgery, marked guarding, neurological symptoms or obvious deformity.
Do not force the test if the client is highly irritable or unsafe to test.
Treatment table or chair
Pain scale
Measurz recording workflow
Optional comparison-side notes
Optional swelling and functional testing notes
Position the client sitting or supine with the ankle relaxed. The knee may be slightly flexed to reduce calf tension.
The foot is usually held in slight plantarflexion, depending on the selected protocol, to bias the ATFL.
Stand or sit facing the foot.
Stabilise the distal tibia and fibula with one hand. Cup the calcaneus and rearfoot with the other hand.
Keep the lower leg stable and minimise hip or knee movement.
Apply a gentle anterior glide to the talus and rearfoot relative to the tibia and fibula.
Ask the client to report pain, apprehension, instability, 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, a firm endpoint and no familiar instability response.
Stop if pain increases sharply, guarding prevents interpretation, instability feels excessive or symptoms are not tolerated.
Compare sides and record pain, laxity and endpoint separately.
A positive Anterior Drawer of the Ankle may increase suspicion of ATFL injury or mechanical ankle instability when increased translation and a softer endpoint are present compared with the uninjured side. It is more meaningful when it matches the mechanism of injury, swelling location, palpation tenderness and functional instability history.
A positive result does not prove the grade of ligament injury. Pain without laxity may reflect acute irritability rather than mechanical instability.
A negative test reduces suspicion of anterior talar laxity in the tested position, but it does not exclude lateral ankle ligament injury, especially in acute presentations with swelling, guarding or pain inhibition.
A 2022 systematic review on physical examination tests for ankle instability found that the anterior drawer test was among tests with higher reported sensitivity in some included studies, but the overall evidence base was variable and no test demonstrated robust reliability and validity across studies.
Condition or presentation: lateral ankle sprain, ATFL injury or chronic ankle instability
Population: people with suspected ankle instability across included studies
Test variation: manual anterior drawer test, with protocol differences between studies
Reference standard: variable across studies, including imaging and clinical criteria
Sensitivity: reported as relatively high in some studies, but not consistent enough to provide one universal value here
Specificity: variable depending on study and test definition
Positive likelihood ratio: not consistently available for one standardised method
Negative likelihood ratio: not consistently available for one standardised method
Key limitations: examiner dependence, variable ankle position, variable force, acute swelling/guarding and inconsistent reference standards
A 2022 systematic review of ligamentous ankle injury tests also concluded that clinical tests are the first opportunity to assess sprain severity, but diagnostic performance depends on test method, injury timing and reference standard.
Reliability depends on ankle angle, degree of relaxation, amount of force, examiner experience, comparison side and how endpoint is graded.
Validity improves when the test is interpreted with injury history, swelling, palpation, talar tilt, functional balance, hop testing and imaging/referral when appropriate.
Common errors include testing too aggressively after acute sprain, not comparing sides, interpreting pain as laxity, failing to record endpoint quality and ignoring fracture risk.
Limitations include guarding, swelling, pain sensitivity, natural laxity, examiner force variation and difficulty grading translation manually.
Use the Anterior Drawer of the Ankle to document anterior talar laxity and instability symptoms. It can support decisions about bracing, return-to-run progressions, balance training, strengthening and referral when instability is marked.
Record test name, side tested, result, pain score, symptom location, ankle position, force direction, translation grade if used, endpoint quality, apprehension, swelling, comparison side, confidence in result and reason for stopping.
Add related findings such as talar tilt, palpation tenderness, ankle ROM, calf raise capacity, balance, hop tests, previous sprain history and return-to-sport notes.
Talar Tilt Test
Prone Anterior Drawer 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 integrity.
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 it does not confirm a tear or injury grade on its own.
Yes. Pain and mechanical laxity provide different information.
Record side, pain score, ankle position, translation, endpoint, apprehension, swelling and comparison side.
The Anterior Drawer of the Ankle assesses anterior talar translation.
A positive result is more meaningful when laxity, endpoint and symptoms match the injury history.
Pain alone is not the same as mechanical instability.
Current evidence supports cautious interpretation rather than stand-alone diagnosis.
Measurz should capture side, position, pain, translation, 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.
