Ankle reflex testing is yet another simple bedside neurologic test which when found to be abnormal is associated with increased risk of foot ulceration (1). The ankle jerk reflex or Achilles reflex is a monosynaptic, deep tendon reflex. As a refresher monosynaptic reflexes have one sensory neuron and one motor neuron. So when a muscle spindle is stimulated it results in contraction of an effector muscle group.

The technique

1. The test is typically performed in the seated position but can be done with the patient supine.

2. The Achilles tendon is stretched until the ankle is in a neutral position.

3. With the ankle in a neutral position strike the tendon with a rubber hammer or similar device. On hospital rounds the diaphragm of a stethoscope is a suitable alternative.

4. If the ankle reflex is absent you can try distraction. One common method is to ask the patient to hook their fingers together and pull.

5.  Absence of an ankle reflex is considered an abnormal result.

Video demonstration