A middle-aged tennis player feels a snap in his left heel while lunging for a ball. He reports being kicked in the back of the ankle. On examination there is a palpable gap 3 cm above the calcaneal insertion and squeezing the relaxed prone calf produces no plantarflexion of the foot. The most appropriate diagnosis is:

• A Rupture of the gastrocnemius muscle belly
• B Partial tear of the soleus
• C Complete rupture of the tendo Achillis ✓
• D Tarsal tunnel syndrome

Explanation

The Thompson (Simmonds) test is diagnostic: absence of plantarflexion when the calf is squeezed with the patient prone indicates a complete Achilles tendon rupture, usually at the watershed zone 2 to 6 cm above the insertion. A palpable gap supports it. Gastrocnemius tears occur higher, at the musculotendinous junction, and preserve some response to calf squeeze.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.