Execution
- 1Position the patient supine or sitting with the ankle relaxed.
- 2Stabilize the distal tibia and fibula with one hand.
- 3Grasp the calcaneus and talus with the other hand.
- 4Translate the talus laterally and medially within the ankle mortise.
- 5Compare pain and side-to-side translation with the opposite ankle.
Positive outcome
Increased medial-lateral talar translation compared with the opposite side, pain, or a soft end feel is positive. The test suggests syndesmosis or mortise instability rather than a simple lateral ligament sprain. A clearly positive finding should raise concern for imaging or orthopedic review.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Sman et al. (2013) | systematic review, limited evidence for individual tests | NA | NA | NA | NA |
CommentCotton testing is a mechanical instability test and may be difficult to interpret without relaxation and side-to-side comparison. Magee lists it in the ankle special-test sequence, but robust diagnostic-accuracy data are limited. Marked laxity is more important clinically than mild discomfort.
Low Clinical Value