Talar Tilt Test

Context

The Talar Tilt Test is primarily used to assess mechanical instability associated with a lateral ankle sprain, particularly an injury to the calcaneofibular ligament (CFL), which may involve the anterior talofibular ligament (ATFL). In the active and athletic adult population, where the incidence of lateral sprains is high, this test is frequently used in post-traumatic or chronic follow-up (Hertel et al., 2002; Netterström et al., 2021).

The choice of the Talar Tilt Test may be justified because, unlike the Anterior Drawer Test, which targets the AFL, it specifically targets the CFL, a ligament less commonly assessed by other maneuvers. The objective is to replicate the tilting mechanism in the frontal plane. It is therefore complementary and clinically useful for guiding management (Hertel et al., 2002; Netterström et al., 2021).

Video of the Test

Execution

To perform the Talar Tilt Test, place the patient in a supine position with the foot in a neutral position at 90°. The practitioner firmly stabilizes the tibia and fibula with one hand, while the other hand grasps the calcaneus. A medial rotational force is applied to stress the lateral aspect of the joint, which primarily strains the CFL.

This test is considered positive if an angle greater than 10° is observed in the total range of motion or if the angle is more than 5° greater than that of the contralateral limb, indicating pathological laxity of the CFL (Gribble, 2019; Bizzini et al., 2025). The patient may also report pain in the area of CFL tension.

Clinical Value

This test is reported to have a sensitivity of approximately 0.5 and a specificity of 0.88 in detecting CFL injury (Bizzini et al., 2025). The Talar Tilt Test would therefore help diagnose a calcaneofibular ligament injury, but there is still no sensitive clinical test for evaluating this ligament (Netterström-Wedin et al., 2021).