Ankle & Foot
Syndesmosis (High Ankle Sprain)
Evidence: confirmed
Crossed-Leg Test Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Diagnosing Syndesmosis injury (High Ankle Sprain).
How to Perform
- Position: Patient sits in a chair.
- Action: Have the patient cross the injured leg over the uninjured knee (like a 'Figure 4' position), so the mid-calf rests on the knee.
- Pressure: Gently push down on the medial side of the injured knee.
Interpretation of Results
- Positive Test: Pain is reproduced at the distal ankle syndesmosis (between the tibia and fibula).
Clinical Context & Limitations
The Crossed-Leg Test should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Ankle & Foot region, combining the Crossed-Leg Test with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment (7th ed.). Elsevier.
