Self-stress vs manual stress in talar tilt radiography

Radiographic study following inversion ankle sprain commonly is used to determine the presence of anatomic laxity across the talocrural joint.

To compare the degree of talar tilt derived from a radiographic ankle stress exam under 2 conditions: self-stress vs manual stress applied by the clinician.

Twenty-four subjects seeking medical care following ankle sprain underwent talar tilt stress exams of both ankles. The involved ankle was imaged with self-stress by use of a strap and with the clinician providing manual stress during the imaging exam. Mean talar tilt for the self-stress method was 2.2 degrees, compared with 5.9 degrees for the manual stress method (P < .001).

Significantly greater and clinically meaningful differences in talar tilt angle were found when manual stress was provided by the clinician. To avoid false negative findings of anatomic laxity in stress talar tilt studies at the ankle, a standardized procedure in which the clinician provides manual stress may be necessary.