Talar Tilt Test

The Talar Tilt Test is an orthopedic assessment used to evaluate ligamentous stability of the ankle, specifically targeting the calcaneofibular ligament and, depending on position, the anterior talofibular ligament (ATFL) and deltoid ligament. This test is essential after ankle inversion injuries (lateral sprains) or eversion injuries (medial sprains).

Talar Tilt Test

How the Test is Performed

  • Client position: Supine or seated, with the leg relaxed and the knee extended.

  • The examiner stabilizes the distal tibia/fibula with one hand, grasps the heel/calcaneus with the other, and positions the ankle:

    • To test calcaneofibular ligament: Keep the ankle in the anatomical neutral position (90°) and invert the hindfoot.

    • To test ATFL: Plantarflex the ankle (~20°) and invert.

    • To test deltoid ligament: Evert the foot (apply valgus stress).

  • Observe for excessive gapping (movement), pain, or a difference in inversion compared to the unaffected side.

    • A positive test: Visibly increased talar tilt (lateral movement >10–15° beyond the opposite side), pain, or a soft end-feel suggests ligamentous injury.

  • Diagnostic accuracy improves when the test is performed with maximum dorsiflexion to “lock” the subtalar joint, and when compared to the uninjured side.

Clinical Significance

  • A positive Talar Tilt Test suggests a partial or complete tear of the calcaneofibular ligament (most sensitive in neutral), and possibly ATFL or deltoid involvement based on ankle position and direction of force.

  • Often used alongside the Anterior Drawer Test for comprehensive ankle instability assessment.

  • Useful for grading mechanical laxity and severity of lateral ankle sprains; specificity up to 88% for combined ligamentous injury.

  • Excess movement or “gapping” may occur normally in very flexible individuals, so always compare sides.

Assessment

  • Utilize the Talar Tilt Test for clients with lateral/medial ankle pain, instability, swelling, or a history of ankle sprain (acute or chronic).

  • Document degree of tilt, end-feel, any pain, and functional findings (gait instability, recurrent sprains).

Treatment

  • If positive:

    • Avoid aggressive mobilization, deep tissue, or strong stretching on the unstable side in acute phases.

    • Use gentle soft tissue techniques for peroneals, tibialis posterior, and stabilizing ankle musculature.

    • Support edema management, proprioceptive retraining, and gradual return to function with bracing/taping as indicated.

    • Educate about avoidance of high-risk activities (pivoting/side cutting) and begin a progressive rehabilitation program if and when medically cleared.

    • Collaborate with physiotherapists for structured rehab, balance/proprioception, and injury prevention.

Safety and Referral

  • Refer for medical assessment/imaging if instability is marked, pain persists, or multiple ligament injuries are suspected.

  • Chronic instability may require orthotic, surgical, or advanced rehabilitation intervention.