Stemcelldoc's Weblog

April 30, 2012

Ankle Anterior Draw Sign: Assessing the stability of the Anterior Talofibular Ligament

Stability is a central theme at the Centeno-Schultz Clinic as discussed in Ortho 2.0.

The anterior talofibular ligament provides critical lateral support to the ankle and has been discussed in prior blogs.

Stability of the anterior talofibular ligament is evaluated by the anterior draw sign whereby the distal part of the leg is stabilized with one hand while the other hand cups the heel.  An anterior pull is applied to the heel attempting to move the talus forward from beneath the tibia.

The anterior drawer test has demonstrated high accuracy in the determination of lateral ankle instability and in the diagnosis of a ligament rupture.

Stem cell therapy is an alternative to traditional ankle surgery and a clinical case has been previously discussed.

At the Centeno-Schultz Clinic the anterior drawer sign can be performed under MSK ultrasound which can distinguish a partial from a complete tear.  The patient is place in the prone position with the foot hanging off the exam table in plantar flexion.  The forefoot is then pulled forward while the tibia is stabilized.  If the ATF is torn the gap between the talus and the tibia/fibula will widen when anterior force is applied which is depicted below.


  1. Doctor,

    Have you treated any patients with lateral ankle instability? What would be recommended PRP or stem cells for laxity in the ligaments? I have recurrent ankle sprains because I sprained it bad in high school during football and played the entire year with a heavily taped ankle. This is one of the problems with high school sports, they want you to play through the pain now and reap the pain later.

    Comment by Will — August 27, 2012 @ 4:03 pm

    • Will,
      We have extensive experience in the treatment of lateral ankle instability. Treatment options typically include prolotherapy but this varies depending upon the severity of the laxity. It is also critical that the injections be performed under ultrasound guidance. Other factors to be considered are the presence or absence of lumbar degenerative disc disease.
      hope this helps.

      Comment by stemcelldoc — August 27, 2012 @ 4:11 pm

      • Thanks for the quick reply doctor. It means a lot. And yes I have a herniated disc l5 -S1 . I will be contacting you guys in the future. I live in Florida. It would be great if you could get some doctors through your training program that are a little more south like Florida or Georgia. I am surprised the big shots like the Miami Marlins/Miami Dolphins or even Jacksonville Jaguars or Tampa Bay Buccaneers Doctors are not certified through your program.

        Comment by Will — August 27, 2012 @ 7:44 pm

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