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Special Test

Achilles Tendon Rupture Tests

The diagnosis of an Achilles tendon rupture is based mainly on the patient history and physical findings.

Physical examination for Achilles Tendon Rupture include the following tests:

  1. Thompson Test,
  2. Matles Test,
  3. Hoffa Sign,
  4. Achilles Tendon Tap Test.

Achilles Tendon Rupture Tests

Thompson Test

Thompson test is the most popular phyical exam used by orthopedic surgeon for Achilles tendon injury.

The patient positioned prone while the examiner gently squeezes the patient’s calf muscle with the palm of his or her hand.

If the Achilles tendon is intact, plantarflexion occurs in the ankle. If the Achilles tendon is torn, the ankle either remains still or only minimal plantarflexion occurs.

See More here: Thompson Test
See Also: Ankle Anatomy

Matles Test

Matles Test is another special test that is used for Achilles Tendon Rupture.

The patient lies in the prone position with the foot over the end of the table and the clinician stands at the end of the table.

The patient is asked to actively flex the knee to 90 degrees while the position of the foot is observed throughout the motion.

If the foot falls into neutral or slight dorsiflexion, the Matles Test test is positive for Achilles tendon rupture (in normal patients, the foot remains in plantar flexion).

Maffulli found this test to have a Sensitivity of 0.88, a Specificity of 0.85, and a positive predictive value of 0.92.

Matles Test

Hoffa Sign

Hoffa Sign indicates a chronic Achilles tendon tear.
The patient is prone with the feet projecting over the edge of the examining table. The examiner passively dorsi flexes both feet.

In a chronic Achilles tendon tear, tension in the Achilles tendon will be reduced and the affected foot can be dorsi flexed farther than the contralateral foot. The patient is then requested to stand on tiptoe on each leg. This will be impossible with an Achilles tendon tear in the injured leg.

The sensitivity and specificity of the for this test have not been reported.

Hoffa Sign

Achilles Tendon Tap Test

Achilles Tendon Tap Test indicates an Achilles tendon tear.

The patient is prone with the knee flexed 90°. The examiner taps the distal third of the Achilles tendon with a reflex hammer.

Increased pain and loss of plantar flexion (Achilles tendon reflex) are signs of a tear in the Achilles tendon. In the absence of an Achilles tendon reflex, a differential diagnosis should exclude neurologic changes.

Achilles Tendon Tap Test

References

  • Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients. Am J Sports Med. 1998 Mar-Apr;26(2):266-70. doi: 10.1177/03635465980260021801. PMID: 9548122.
  • Padanilam TG. Chronic Achilles tendon ruptures. Foot Ankle Clin. 2009 Dec;14(4):711-28. doi: 10.1016/j.fcl.2009.08.001. PMID: 19857844.
  • Clinical Tests for the Musculoskeletal System 3rd Edition.
  • Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
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