A 35-year-old long-distance runner presents with sudden severe posterior heel pain during a sprint, with a palpable gap above the calcaneum. Thompson's test is positive. What is the most accurate interpretation of a positive Thompson's test?

• A Absence of plantar flexion on squeezing the calf, confirming complete Achilles tendon rupture ✓
• B Pain on dorsiflexion of the foot, confirming Achilles tendinopathy
• C Passive plantar flexion of the foot on calf squeezing, confirming intact Achilles tendon continuity
• D Loss of dorsiflexion power, confirming tibialis anterior rupture

Explanation

In the Thompson (Simmonds) test, the patient lies prone and the calf is squeezed; in an intact Achilles tendon, this produces passive plantar flexion. A positive (abnormal) test means the foot does NOT plantar flex when the calf is squeezed, indicating loss of mechanical continuity — confirming complete Achilles tendon rupture. The test is highly sensitive (>90%) for complete rupture. Partial tears may give a false-negative result.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.