Eversion Stress Test

The Eversion Stress Test is performed to evaluate the integrity of the deltoid ligament complex and to detect medial ankle instability following a sprain¹ ². The deltoid ligament, located on the medial side of the ankle, provides strong stabilization. Injury to this structure can cause significant joint instability, functional impairment, and long-term ankle dysfunction if untreated.

Test Procedure

Patient position

• The patient may lie supine, side-lying, or sit upright.

• To reduce gastrocnemius tension, the knee is flexed to 90°.

Execution

• The examiner stabilizes the distal tibia and fibula with one hand.

• The other hand cups the calcaneus from below.

• With the ankle in neutral, the examiner applies an abduction (valgus) force to the calcaneus, producing a medial talar tilt.

Interpretation

• Positive test:

  • Increased talar tilt or pain localized over the deltoid ligament compared with the contralateral side.

  • A soft or spongy end-feel may indicate complete ligament rupture³ ⁴.

• Quantitative criteria:

  • A talar tilt difference of ≥2° compared to the opposite ankle significantly raises the likelihood of a deltoid ligament tear⁵.

Clinical Evidence and Diagnostic Validity

• A valgus talar tilt occurs when both superficial and deep fibers of the deltoid ligament are injured.

• Testing in neutral ankle position stresses primarily the superficial fibers.

• Assessing through the full ankle range of motion allows evaluation of different portions of the ligament⁶.

➡ Despite its clinical use, current evidence on the test’s sensitivity, specificity, and predictive value is limited.

Clinical Relevance

The Eversion Stress Test is a quick, simple tool to assess medial ankle instability after trauma.Key findings that suggest deltoid ligament injury:

• Pain directly over the ligament.

• Greater talar tilt compared with the contralateral side.

⚠️ Because diagnostic accuracy remains uncertain, the test should be combined with:

• Palpation

• Functional ankle tests

• Imaging (stress radiographs, ultrasound, MRI) when indicated.

Conclusion

The Eversion Stress Test is a straightforward clinical examination to detect medial ankle instability due to deltoid ligament injury. While pain reproduction and increased talar tilt strongly suggest pathology, the limited diagnostic evidence means the test should not be used in isolation. A combined approach with additional clinical assessments and imaging provides the most accurate diagnosis.

References

1. Starkey C, Brown SD. Examination of orthopedic & athletic injuries. FA Davis; 2015 Feb.

2. de Vries JS, Kerkhoffs GM, Blankevoort L, van Dijk CN. Clinical evaluation of a dynamic test for lateral ankle ligament laxity. Knee Surg Sports Traumatol Arthrosc. 2010 May;18(5):628-33. 

3. Prentice W, Arnheim D. Principles of athletic training: A competency-based approach. McGraw-Hill Higher Education; 2013 Jan 25.

4. Manganaro D, Alsayouri K. Anatomy, Bony Pelvis and Lower Limb, Ankle Joint. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2020.

5. Leith JM, McConkey JP, Li D, Masri B. Valgus stress radiography in normal ankles. Foot & ankle international. 1997 Oct;18(10):654-7.

6. Magee DJ. Orthopedic physical assessment 5th ed. St. Louis, Mo, Saunders Elsevier. 2008.