The anterior drawer test is used to assess anterior talar translation relative to the tibia, primarily to help evaluate the integrity of the anterior talofibular ligament (ATFL). It is most commonly used when a lateral ankle sprain is suspected and should be interpreted alongside the injury history, observation, palpation, and other clinical findings rather than in isolation.
Use this test when you want to assess:
suspected lateral ankle ligament injury
possible ATFL involvement
feelings of ankle instability after an inversion mechanism
side-to-side differences in perceived anterior laxity
whether mechanical laxity may be contributing to ongoing symptoms or recurrent sprains
treatment table or plinth
towel or pillow if needed for comfort
optional marker or note template for documenting pain, end-feel, and side-to-side difference
No special equipment is required for the manual test itself.
client lies supine
knee is flexed to help relax the gastrocnemius
ankle is placed in a comfortable slight plantarflexion position
lower leg is stabilised
test is performed the same way on both sides
compare the amount of translation, end-feel, and symptom response side to side
Position the client lying on their back on the table.
Flex the knee so the lower leg is relaxed.
Place the ankle in slight plantarflexion.
Stabilise the distal tibia and fibula with one hand.
Cup the calcaneus with the other hand.
Draw the heel and talus anteriorly while keeping the lower leg fixed.
Assess:
the amount of anterior movement
the quality of the end-feel
pain reproduction
apprehension or guarding
Repeat on the unaffected side using the same setup.
Compare the two sides before drawing conclusions.
testing with too much muscle guarding
not stabilising the lower leg properly
pulling the whole foot instead of controlling the heel/talus
testing in an inconsistent ankle position
relying only on pain and ignoring end-feel and side-to-side comparison
treating the test as diagnostic on its own without using the rest of the clinical examination
Increased anterior translation compared with the other side may suggest ATFL laxity.
A soft or delayed end-feel may also support mechanical laxity.
Pain alone does not confirm instability.
In the acute setting, swelling, pain, and guarding can affect the result, so interpretation should stay cautious.
The anterior drawer test is best used as part of a cluster of findings, not as a standalone diagnosis.
The anterior drawer test is useful for assessing possible ATFL-related laxity, but it works best when the setup is standardised and the result is compared side to side. It should support your overall assessment, not replace it.
Beynon, A. M., Murphy, D. F., & Allet, L. (2022). Reliability and validity of physical examination tests for the diagnosis of ankle sprains and instability: A systematic review. Physical Therapy in Sport, 58, 190â204. https://pubmed.ncbi.nlm.nih.gov/36536446/
Martin, R. L., Davenport, T. E., Fraser, J. J., Sawdon-Bea, J., Carcia, C. R., Carroll, L. A., Kivlan, B. R., & Carreira, D. (2021). Ankle stability and movement coordination impairments: Lateral ankle ligament sprains revision 2021. Journal of Orthopaedic & Sports Physical Therapy, 51(4), CPG1âCPG80. https://doi.org/10.2519/jospt.2021.0302
