Heel Thump Test

 Heel Thump Test

What is Heel Thump Test?

Heel Thump Test (or as it called Heel Percussion Test) is a clinical procedure used to evaluate the tibia bone for the presence of stress fracture. It is also used for evaluating ankle injuries to differentiate syndesmotic sprains from lateral ankle sprains.

Heel Thump Test was first described by Lindenfeld & Parikh in 2005.

See Also: Ankle and Foot Anatomy

How it’s Performed?

Heel Thump Test
Heel Thump Test

What does a positive Heel Thump Test mean?

Heel Thump Test is positive if pain is experienced at the distal tibiofibular syndesmosis, this suggests the presence of injury.

Although the heel thump test has been recommended to help differentiate between a syndesmotic injury and a lateral ankle sprain, it is also used for tibial stress fractures.

Sensitivity & Specificity

The diagnostic accuracy of this test is unknown.


Related Anatomy

Ankle Ligaments Anatomy

LigamentProximal AttachmentDistal AttachmentFunction
Anterior inferior tibiofibularTibiaFibulaStability of ankle mortise
Interosseous ligamentTibiaFibulaStability of ankle mortise
Posterior inferior tibiofibular ligamentTibiaFibulaStability of ankle mortise
LigamentProximal AttachmentDistal AttachmentFunction
Anterior talofibular Lateral malleolusTransversely to talus anteriorlyLimits inversion in plantar flexion
CalcaneofibularLateral malleolusObliquely to calcaneus posteriorlyLimits inversion in neutral or dorsiflexion
Posterior talofibularLateral malleolusTransversely to talus posteriorlyLimits posterior talar displacement and external rotation
LigamentProximal AttachmentDistal AttachmentFunction
Tibionavicular Medial malleolusNavicular tuberosityLimits talar external rotation
TibiocalcanealMedial malleolusSustentaculum taliLimits hindfoot eversion
Anterior tibiotalarMedial malleolusMedial surface of taluLimits lateral displacement of talus, external rotation
Posterior tibiotalarMedial malleolusInner side of talusLimits lateral displacement


  1. Edward P. Mulligan. Evaluation and management of ankle syndesmosis injuries. May 2011 Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine 12(2):57-69. Researchgate.
  2. Clinical Tests for the Musculoskeletal system 3rd Edition.

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