The TOAST (Traction on Ankle Stress Test): A Supplemental Clinical and Dynamic Ultrasound Examination Approach for Focal Assessment of Axial Ankle Joint Instability.

Ankle drawer and varus-valgus stress tests have evolved to examine for excessive joint displacement in the sagittal and coronal planes which may correlate to ligament instability. However, there appear to be no formal manual test(s) assessing for axial plane (longitudinal) instability of the mortise joint. In keeping with Cartesian and Cyriax principles, The TOAST (Traction On Ankle Stress Test) was developed to dynamically assess for 3^rd vector axial strain pain generation and long-axis mortise joint gapping. The test is easy to learn as longitudinal manual traction of the mortise joint and applied counterforce hand positions are similar to emergent ankle fracture dislocation reduction technique. The TOAST may also be performed under dynamic ultrasound control.