Thompson Test for Torn Achilles Tendon

The Thompson Test is performed when making the diagnosis of a torn Achilles tendon. This should not be confused with the Thomas test, used to assess hip joint problems.

Man holding his Achilles tendon in pain
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Achilles Tendon Tears

An Achilles tendon tear occurs when the tendon that connects the calf muscle to the heel bone is severed. This injury often occurs during sports activities such as basketball or tennis and is felt by the athlete as a sudden sharp pain directly behind the ankle. Most often, Achilles tendon tears are non-contact injuries. Patients often describe hearing a sudden pop in their ankle and then turning to see if someone kicked them, only to have no one around. 

Typical symptoms of an Achilles tendon tear include pain behind the ankle joint, swelling of the tendon, and difficulty walking. Some patients know right away what has happened, in others the condition is a little less clear. That is where a good physical examination by an experienced clinician can be helpful. As part of their examination, your healthcare provider will perform the Thompson test.

Performing the Thompson Test

To perform the Thompson test, the patient should lie face-down on the examination table. The feet extend farther than the end of the bed. The examiner then squeezes the calf muscle. This motion, in a normal patient, should cause the toes to point downward as the Achilles pulls the foot. In a patient with a ruptured Achilles tendon, the foot will not move. That is called a positive Thompson test.

The Thompson test is important because some people who tear their Achilles are still able to point their toes downwards, although the Thompson test would still be positive. These patients have other muscles and tendons the can work to point the toes down that are not injured (usually the toe flexors or the posterior tibialis), however, even in these patients, the Thompson test will still be positive. Therefore, this is a valuable clinical tool to help make the diagnosis of this condition.

Treatment Options

There are several options for treatment of a torn Achilles tendon. These options include both surgical and nonsurgical treatments. The best treatment depends on the specific situation and the needs and expectations of the patient. The good news is, that both surgical and nonsurgical treatment of Achilles tendon tears can lead to full recovery, and therefore there are options that can be considered.

Most athletic patients are choosing a surgical repair as the recovery does seem to be faster, although even with surgical treatment a full recovery can take 6 months or longer. In addition, as with any surgical procedure, there are risks of surgery that should be considered prior to treatment.

2 Sources
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  1. Cedars-Sinai. Achilles Tendon Injuries.

  2. Somford MP, Hoornenborg D, Wiegerinck JI, Nieuwe weme RA. Are You Positive That the Simmonds-Thompson Test Is Negative? A Historical and Biographical Review. J Foot Ankle Surg. 2016;55(3):682-3. doi:10.1053/j.jfas.2016.01.021

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.