Execution
- 1Position the patient sitting or lying with the leg supported.
- 2Stabilize the lower leg with one hand.
- 3Use the other hand or fist to apply a firm thump to the center of the heel.
- 4Direct the force in line with the long axis of the tibia.
- 5Ask where pain is produced.
Positive outcome
Pain in the ankle or syndesmosis region is positive for a possible syndesmosis injury. Pain along the tibial shaft may indicate a stress fracture rather than syndesmosis injury. The pain location must be documented.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Sman et al. (2013) | systematic review, limited individual-test evidence | NA | NA | NA | NA |
CommentMagee specifically warns that tibial shaft pain with heel thump may indicate stress fracture. The test is a broad axial-load provocation, not a specific syndesmosis test. Use it carefully and avoid strong impact when fracture is a concern.
Low Clinical Value