Talar Tilt: Physical Exam

- Discussion:
- talar instability is assessed w/ talar tilt test, in which angle formed by tibial plafond & talar dome is measured as inversion force is applied to hindfoot;
- talar tilt test is useful for evaluation of a combined injury of both the anterior talofibular and the calcaneofibular ligaments.
- isolated rupture of the calcaneofibular ligament probably does not cause demonstrable ankle laxity;
- talar tilt to range from 0 to 23 degrees but most normal ankles have a tilt of approx 5 deg or less;
- testing w/ ankle in plantar flexion assesses anterior talofibular ligament primarily and the calcaneofibular ligament secondarily;
   - when the anterior talofibular ligament alone is ruptured, small increases in talar tilt are noted;
   - combined rupture of anterior talofibular ligament & calcaneo-fibular ligament results in increased talar tilt;
- Method of Testing:
- talar tilt test is performed w/ patient seated & w/ ankle & foot unsupported in 10 to 20 degrees of plantar flexion;
- examiner stabilizes the medial aspect of the distal part of leg,  just proximal to medial malleolus, with one hand & applies inversion 
   force slowly to the hindfoot with the other hand;
- lateral aspect of the talus should be palpated during inversion of hindfoot to determine if tilting is occurring at ankle joint

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, November 26, 2012 2:42 pm