Keen’s Sign is an ankle examination test that determines the presence of a fracture and severe ankle ligament damage. Keen’s sign is the abnormal width of one ankle in relation to the other.


Patient should be awake and cooperative when Keen’s sign is done.

  1. Patient should be seated or supine during the procedure.
  2. The examiner uses a measuring tape to measure the diameter of the ankle around the malleoli.
  3. The examiner checks for signs of pain and edema and compares the measurements bilaterally.

The examiner measures the diameter of the ankle.


Positive Keen’s Sign

There is positive Keen’s sign when there is increased diameter around the affected ankle. This indicates the presence of fracture (Pott’s) or severe ankle ligament damage.

Clinical Notes

The examiner must immediately proceed with diagnostic imaging once a positive Keen’s test is seen.