External Ankle Rotation Test

The external ankle rotation test is used to diagnose high ankle sprains by evaluating pain responses and joint stability.


What is a High ankle sprain?

A high ankle sprain is a tear of the tibiofibular ligament at the top of the ankle. It is more severe than a common sprained ankle because it often occurs along with a fracture. As a result, it is usually more difficult to treat.

The most commonly injured ligament in a high ankle sprain is the anterior tibiofibular ligament. The anterior tibiofibular ligament connects the tibia to the fibula at the front of the ankle. Its function is to prevent the two bones separating when standing, walking or running. Severe injuries can also cause damage to the syndesmosis which is a membrane connecting the Tibia and Fibula.

How to perform the external ankle rotation test?

First, ensure the patient is seated with their legs dangling over the edge of the exam table. Position yourself in front of the patient. Then, firmly grasp the patient’s foot. Next, stabilize the patient’s leg with your other hand.

Hold the foot and rotate it outward gently but firmly. Observe any signs of pain or discomfort. This reaction might indicate a high ankle sprain. Finally, compare these findings with the other ankle. Look for differences in pain or movement.

What is a positive external ankle rotation test?

A positive external ankle rotation test is indicated when the patient experiences pain or discomfort as their foot is gently but firmly rotated outward. Specifically, this pain, particularly when compared to the other ankle, suggests the presence of a high ankle sprain. Moreover, observing differences in pain or movement between the two ankles helps confirm the diagnosis.


Use this test in conjunction with the squeeze test and the Internal ankle rotation test to help diagnose a high ankle sprain. Also, be mindful of the patient’s pain tolerance; excessive force can worsen injuries. Consider additional imaging or a specialist consultation for a more detailed assessment.

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