Protocol used for clinical tests in the included studies
| Test | Authors | Protocol | Positive findings |
|---|---|---|---|
| Squeeze test | Nussbaum et al16 | Patient sitting over side of the bed. Compression of fibula to the tibia above the midpoint of the calf | Pain over area of the syndesmosis ligaments |
| Alonso et al36 | |||
| Beumer et al26 | |||
| Dorsiflexion with compression test | Alonso et al36 | Patient standing and actively dorsiflexing the ankle. Performed once unassisted and once with the therapist applying a manual compressive force to the malleoli | Significant increase in ankle range of motion when compression added, or decreased pain at end of range when compression added |
| Dorsiflexion range of motion | Beumer et al26 | Application of passive dorsiflexion | Reduced dorsiflexion range of motion compared with contralateral ankle |
| External rotation test | Alonso et al36 | Participant sitting over side of the bed. Application of a passive external rotation stress to affected foot and ankle with the knee at 90°and ankle in neutral | Pain over the syndesmosis ligaments |
| Beumer et al26 | |||
| Nussbaum et al16 | Performed with the ankle passively and maximally dorsiflexed in external rotation on a fixed lower leg | Reproduction of pain along the syndesmosis | |
| Palpation | Nussbaum et al16 | Palpation over anterior tibiofibular ligament | Report of pain after pressing directly over the ligament |
| Alonso et al36 | |||
| Cotton test | Beumer et al26 | Distal tibia stabilised and lateral force applied to the foot | Increased lateral translation of the talus from medial to lateral compared with contralateral side |
| Fibula translation | Beumer et al26 | Apply anterior–posterior translation of the fibula | Anteroposterior displacement of the fibula is greater than contralateral side |
| Anterior drawer | Beumer et al26 | Not described | Used as a differential diagnosis between lateral collateral instability and syndesmosis instability |