Achilles Tendon Rupture: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
    • Inspection (viewing).
      • Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes.
      • Gait (fluid, limping).
      • Body or joint posture (upright, bent, gentle posture).
      • Joint (abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation).
    • Inspection and palpation (palpation) of the Achilles tendon [limited plantar flexion strength; lack of preload on the tendon; palpable gap/dimple above the heel palpable (sometimes also visible)]
    • Assessment of pain on movement, range of motion, resilience, muscle strength (toe stand single legged).
    • Thompson test: compression of the calf of the affected leg does not lead to pointed foot Execution of the test: the patient lies on his stomach, the feet hang over the edge of the examination couch. If the calf muscle is compressed from both sides, plantar flexion of the foot (lowering of the sole of the foot towards the ground = pointed foot) normally occurs, but not in the case of an Achilles tendon rupture. In the case of complete rupture, the Thompson test is positive, i.e. compression of the calf of the affected leg does not lead to pointed foot: Attention! The test is positive only in about two-thirds of cases.The test has the highest sensitivity (0.96) and specificity (0.93).
    • Knee flexion test (Matles test):In the affected leg, there is no passive plantar flexion in the ankle joint.Performance of the test: in the prone position, both knees are bent to 90 °.The test has the sensitivity (0.88) and specificity (0.85).
    • Assessment of blood flow, motor function and sensitivity:
      • Circulation (palpation of pulses).
      • Motor function: testing of gross strength in lateral comparison.
      • Sensibility (neurological examination including examination of the Achilles tendon reflex).

Square brackets [ ] indicate possible pathological (pathological) physical findings.