Execution
- 1Position the patient prone with the ankle relaxed and the Achilles tendon exposed.
- 2Palpate along the Achilles tendon from the calcaneal insertion proximally.
- 3Compare tendon continuity and contour with the opposite side.
- 4Identify any palpable gap, step-off, or soft defect.
- 5Repeat gently with the ankle relaxed and avoid pressing excessively into acute swelling or bruising.
Positive outcome
A palpable gap, defect, or step-off in the Achilles tendon is positive for rupture. Absence of a palpable gap does not exclude rupture because swelling, hematoma, or plantaris continuity may obscure the defect. The finding is more helpful when combined with Thompson and Matles testing.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Maffulli (1998) | prospective clinical study | 73 | NA | NA | NA |
CommentMaffulli reported gap palpation as the least sensitive of the common Achilles rupture signs in the awake patient. Swelling and pain can hide a rupture, so a negative palpation test should not reassure the examiner if Thompson or Matles is positive. Treat it as an adjunct rather than a primary rule-out test.
Moderate Clinical Value