Note the obvious widening of the joint space during plantar flexion on the left compared to dorsiflexion on the right. Thus, with this understanding of the articulation of the talus within the mortise, it is not surprising that most ankle injuries occur while the ankle is in plantar flexion, rather than in dorsiflexion. The last part of the clinical examination of an injured ankle involves assessing the stability of the ankle joint. The two maneuvers that can be performed to assess the stability of the ankle joint are the anterior drawer and talar tilt maneuvers. Keep in mind that the ability to perform these tests and the results immediately after an injury may be limited by swelling, pain and muscle spasm. Do not attempt to perform either of these tests if there is an obvious deformity of the ankle suggestive of a possible ankle fracture.

The ATFL ligament normally prevents the anterior subluxation of the talus from the mortise. The talus may be subluxed anteriorly whenever the ATFL is partially ruptured (second-degree sprain) or completely ruptured (third-degree sprain). The anterior drawer maneuver assesses the integrity of the ATFL. Since the ATFL is usually the first ligament to be injured in a typical inversion injury, some physicians feel that if this anterior drawer test is negative, it is then unnecessary to perform the talar tilt maneuver (since the talar tilt stress test is positive only if both the ATFL and the CFL are injured). To perform the anterior drawer maneuver, the patient can either be supine or sitting down, with the ankle in neutral position. One hand of the examiner cups the heel of the affected ankle (and attempts to pull the foot anteriorly), while the other hand braces along the anterior aspect of the lower leg.