Standard examination of the ankle joint according to Cyriax’s orthopedic medicine in the context of ligamentous instability

Lateral ankle sprain (LAS) is one of the most common lower limb injuries, particularly in physically active individuals. A frequent complication is ankle instability—mechanical (MAI), resulting from ligamentous and capsular damage, and functional (FAI), manifested as the subjective sensation of the ankle “giving way.” Recurrent sprains significantly increase the risk of ankle osteoarthritis, highlighting the importance of accurate diagnostics. Standard tests, such as the anterior drawer test, often yield inconsistent results; therefore, comprehensive functional evaluation is crucial. It should include patient history, passive and resisted tests, palpation, and imaging, with particular attention to clinical presentation and reported symptoms rather than solely morphological changes. The Cyriax protocol is based on selective tissue tension and clinical pattern analysis. It encompasses ligamentous tests of the ankle (lateral, medial, syndesmotic), capsular and muscular tests, assessment of the midfoot joints, and resisted tests of the lower leg and foot muscles. Complementary tools include palpation and validated questionnaires assessing the patient’s functional status. The method also enables early detection of “red flags” requiring advanced imaging. The Cyriax examination is simple, clinically useful, and applicable in both acute and chronic post-traumatic conditions. It facilitates the identification of structural damage and functional deficits, allowing targeted rehabilitation tailored to the patient’s needs. Importantly, this approach supports not only structural assessment but also functional therapy planning, provided that test results are always interpreted in the context of patient history and the overall clinical picture.