title: Diagnostic accuracy of physical examination tests of the ankle/foot complex: a systematic review.
abstract: BACKGROUND
  Orthopedic special tests of the ankle/foot complex are routinely used during the physical examination process in order to help diagnose ankle/lower leg pathologies.
  
  
  OBJECTIVE
  The purpose of this systematic review was to investigate the diagnostic accuracy of ankle/lower leg special tests.
  
  
  METHODS
  A search of the current literature was conducted using PubMed, CINAHL, SPORTDiscus, ProQuest Nursing and Allied Health Sources, Scopus, and Cochrane Library. Studies were eligible if they included the following: 1) a diagnostic clinical test of musculoskeletal pathology in the ankle/foot complex, 2) description of the clinical test or tests, 3) a report of the diagnostic accuracy of the clinical test (e.g. sensitivity and specificity), and 4) an acceptable reference standard for comparison. The quality of included studies was determined by two independent reviewers using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool.
  
  
  RESULTS
  Nine diagnostic accuracy studies met the inclusion criteria for this systematic review; analyzing a total of 16 special tests of the ankle/foot complex. After assessment using the QUADAS-2, only one study had low risk of bias and low concerns regarding applicability.
  
  
  CONCLUSIONS
  Most ankle/lower leg orthopedic special tests are confirmatory in nature and are best utilized at the end of the physical examination. Most of the studies included in this systematic review demonstrate notable biases, which suggest that results and recommendations in this review should be taken as a guide rather than an outright standard. There is need for future research with more stringent study design criteria so that more accurate diagnostic power of ankle/lower leg special tests can be determined.
  
  
  METHODS
  3a.
authors.affiliation: Walsh University, North Canton, OH, USA.
authors.forename: Braun
authors.initials: B
authors.lastname: Schwieterman
authors.forename: Deniele
authors.initials: D
authors.lastname: Haas
authors.forename: Kirby
authors.initials: K
authors.lastname: Columber
authors.forename: Darren
authors.initials: D
authors.lastname: Knupp
authors.forename: Chad
authors.initials: C
authors.lastname: Cook
keywords: Ankle; leg; physical examination; sensitivity and specificity; systematic review