Thompson Test for Achilles Tendon Rupture

What is the Thompson test?

The Thompson test is a physical test healthcare providers use to diagnose an Achilles tendon rupture (tear). Healthcare providers sometimes call it the calf squeeze test.

A provider will squeeze your calf muscle on the back of your lower leg to see if your heel moves. Usually, your heel will move a little with your calf muscle because your Achilles tendon connects it to your heel bone (calcaneus). If your heel doesn’t move, your Achilles tendon may be torn.

When is it performed?

A healthcare provider will perform a Thompson test if they think you might have a ruptured (torn) Achilles tendon.

The Thompson test is an in-office physical exam, which means your provider can perform it without any special equipment or a separate appointment. It’s usually part of a preliminary exam if you have symptoms of an Achilles tendon tear (feeling or hearing a pop in your ankle, pain or swelling), especially if you’ve experienced a sports injury.

You’ll probably also need at least one type of imaging test to confirm the rupture.

How does the Thompson test work?

The Thompson test is a quick, easy way for a healthcare provider to check for an Achilles tendon rupture. The test includes the following steps:

• You’ll lie on your stomach (prone) with your feet and ankles hanging over the edge of an exam table.
• Your provider will gently squeeze your calf muscle.
• They’ll look to see if your heel and foot move at all while they’re squeezing.
• Your provider might perform the test on both your legs to see how much your uninjured Achilles tendon moves your heel to compare it to the injured side.

How do I prepare?

You don’t need to do anything to prepare for a Thompson test. Visit a healthcare provider right away if you think you have a torn Achilles tendon — especially if you hear or feel a pop in the back of your ankle right before your injury.

What should I expect during the test?

Try to relax during the test. It might be harder for your provider to get an accurate result if you’re tensing your muscles.

The Thompson test shouldn’t make pain or any other symptoms of a torn Achilles tendon worse. Tell your provider if anything hurts during the test.

What happens after the Thompson test?

If your provider thinks you might have a torn Achilles tendon, you’ll probably need at least one type of imaging test like an ultrasound or magnetic resonance imaging (MRI).

What type of results will I get and what do they mean?

The Thompson test doesn’t give the kind of results you might have gotten on other medical tests. Instead of giving an exact range or a specific number, it helps your provider understand whether or not your Achilles tendon is ruptured.

It’s more like a true or false question and less like a math problem that has an exact answer. Your provider will classify your Thompson test as positive if they find anything that indicates that your Achilles tendon is ruptured. A negative result means your heel moved like it should or that your provider doesn’t think your Achilles is ruptured based on that one test.

Your provider will suggest treatments based on what they find during the tests. Many people need surgery to repair a ruptured Achilles tendon. Talk to your provider about what to expect.

When should I call my provider?

Visit a healthcare provider if you think you might have a torn Achilles tendon, including any of the following symptoms:

• A snap or pop at the back of your ankle, especially during intense physical activity.
• Sudden, sharp pain at the back of your ankle.
• Difficulty walking after an injury.

What are other physical tests that check for Achilles tendon rupture?

The Thompson test is one of three common physical tests providers do to check for an Achilles tendon rupture. The other two are:

• The Matles Test: The Matles test is similar to the Thompson test. You’ll lie on your stomach (prone) and either hang your feet off the exam table or raise your lower legs to 90 degrees (perpendicular to your thighs). Your Achilles tendon keeps tension on your foot, so it’s usually steady and slightly angled. If your tendon is ruptured, your foot will hang loose and fall flat.
• Achilles tendon palpation: Palpate is the medical term for your provider feeling something with their fingers. Your provider will probably palpate your Achilles tendon in addition to other tests. The Achilles tendon is big and thick enough that your provider can feel it through your skin. If it’s partially or completely torn, your provider will be able to feel a gap in your ankle around the tear.

No matter which physical tests your provider uses, you’ll probably still need at least one type of imaging test to take pictures of your tendon and the area around it.

Is it OK to walk with a ruptured Achilles tendon?

Most people can walk and move their ankle with a ruptured Achilles tendon. However, it might be painful or difficult. Visit a healthcare provider right away if you think you have an Achilles tendon injury, even if you can walk or put some weight on it.

Using your ankle and putting your full weight on it can make injuries (including Achilles tendon ruptures) worse. Use crutches, a walker or other mobility aids if you have them while you’re waiting for a provider to diagnose your injury.

A note from Cleveland Clinic

Achilles tendon ruptures are common injuries, especially for athletes. The Thompson test is usually the first way your provider will check to see if your Achilles tendon is ruptured. It’s safe, effective and simple. You’ll still probably need other tests (like an ultrasound or MRI) to take pictures of your tendon, especially if your provider thinks it’s ruptured.

Recovering from an Achilles tendon tear can take time (and lots of hard work). You might not even remember the Thompson test when you’re back out on the field or court, but it’s a quick first step on your recovery journey.