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Clinical exam · Musculoskeletal system

Thompson test !

  • Maneuver

Squeezing the calf of a person lying face down should point the foot downward; if the foot does not move, the Achilles tendon is torn.

Updated 2026-11-01

See it in 3D: Achilles tendon · Gastrocnemius (inner head) · Gastrocnemius (outer head) · Soleus · Calcaneus

What it is

The Thompson (or Simmonds-Thompson) test checks the continuity of the Achilles tendon. Squeezing the triceps surae mass makes an intact tendon pull on the calcaneus and the foot plantarflexes; if the tendon is completely torn, the foot does not move. It is very useful because many patients with a rupture can still move the foot using other muscles.

The anatomy it tests

  • The Achilles tendon joins the two heads of gastrocnemius and the soleus (triceps surae) to the calcaneal tuberosity.
  • Squeezing the muscle mass shortens the unit and, if the tendon is intact, pulls the calcaneus up so the foot points down.
  • If the tendon is torn, the force does not reach the calcaneus and the foot does not move.
  • The long toe flexors and tibialis posterior can produce some active plantar flexion, which confuses the exam.

How to do it

  1. Patient prone with both feet hanging over the edge of the table and the muscles relaxed (or kneeling on a chair).
  2. Inspect how both feet hang: the torn side usually hangs closer to neutral.
  3. Feel along the tendon for a gap above the calcaneus.
  4. The examiner squeezes the widest part of the calf with one hand, healthy side first.
  5. Normal: the foot plantarflexes on squeezing.
  6. Positive Thompson: no plantar flexion, or much less than on the healthy side.

What a positive result means

  • Positive: complete Achilles tendon rupture.
  • Typical story: sudden heel pain when pushing off or jumping, like a kick or a blow from behind, sometimes with a pop.
  • Associated factors: occasional sport in middle-aged adults, prior tendinopathy, corticosteroid or fluoroquinolone use.
  • A partial tear can give a normal test.
  • Pain and thickening with no gap and a normal Thompson point to Achilles tendinopathy.

Usefulness and limits

  • Sensitivity and specificity for complete rupture are high, although the data are limited.
  • Ultrasound confirms the rupture and measures the gap between the ends.

Test yourself

Think of the answer, then tap the question to see it.

What is the normal result of the Thompson test?

When the calf is squeezed, the foot plantarflexes.

What does it mean when the foot does not move as the calf is squeezed?

A complete rupture of the Achilles tendon.

Why can a patient with an Achilles rupture still point the foot down?

Because the long toe flexors, flexor hallucis longus and tibialis posterior can produce some plantar flexion.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

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Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Thompson Test in Achilles Tendon Rupture (Journal of Education and Teaching in Emergency Medicine (JETem), 2016); Musculo-Skeletal Exam – Practical Guide to Clinical Medicine (UC San Diego School of Medicine, 2026).

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Representative model, for educational purposes only.