Thompson Test

The Thompson Test (also known as the calf squeeze test) is a clinical orthopedic exam used to assess for Achilles tendon rupture (tear). It is considered a highly sensitive and specific test for detecting full or partial discontinuity of the Achilles tendon after trauma or acute plantar flexion injury.

How the Test is Performed

• Client position: Prone (lying face down) with feet hanging freely off the edge of the table/bed.

• The therapist firmly squeezes the calf muscle (gastrocnemius/soleus) in the mid-leg.

• Normal/integrity: The foot should move downward (plantarflex) when the calf is squeezed—as the intact Achilles tendon transmits force from the calf to the heel.

• Positive test: Absence of plantar flexion, or markedly reduced/weak movement, indicates Achilles tendon rupture (partial or full tear).

  • If plantarflexion occurs, the tendon is likely intact. Partial tears may have subtle, diminished movement.

  • Compare with the unaffected side for clarity.

Clinical Significance

• A positive Thompson Test is a core finding for acute Achilles rupture, confirmed as highly sensitive (up to 96%) and specific (up to 93%).

• It helps guide urgent referral for surgical/non-surgical management and prevents misdiagnosis when promptly performed after injury.

• False negatives may occur if the test is done incorrectly, or in cases of partial ruptures, so it should be supplemented with palpation, patient history, and, if needed, imaging.

Assessment

• Use for clients with acute calf pain/swelling, sudden loss of push-off strength, feeling/hearing a “pop” in the ankle, or after severe trauma/sport injury.

• Document whether plantar flexion is present or absent, the side affected, and the presence of swelling, deformity, or bruising.

• Complement with visual inspection and palpation for indentation (“gap”) or swelling above the heel.

Treatment

• If positive:

  • Do not perform deep tissue work, stretching, or mobilization on the affected tendon—any manual therapy is strictly contraindicated until cleared by a specialist.

  • Educate the client to immobilize the ankle, avoid weight-bearing, and seek urgent medical/orthopedic evaluation.

  • Only begin gentle massage and rehabilitation after adequate healing/stabilization and with specialist clearance.

• If negative but suspicion remains high (e.g., persistent loss of function): Refer for imaging or specialist evaluation.

Safety and Referral

• Achilles ruptures require prompt specialist care for optimal recovery; delayed treatment increases risk of chronic disability.

• Post-operative/post-conservative care: Massage therapists may work on surrounding soft tissue for edema, pain, and to support mobility once cleared by the care team.