Thompson’s aka Simmonds Test – patient prone, squeeze calves
Palpable gap
Weakness in plantar flexion
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How will you investigate? What sign on XR?
XR – Obliteration of Kager’s triangle in presence of rupture
US/ MRI
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What are you looking for in advanced imaging?
Confirm the injury and to evaluate extent of retraction
No consensus on looking at extent of retraction but literature has described the use of US to evaluate suitability of non-operative treatment. Several surgical units use the cut off of 5mm to determine non apposition of the tendons.
Kotnis et al. AJSM 2006 - dynamic US with foot in equinus. Patients with gap of > 5mm ➔ surgery; gap < 5mm ➔ no surgery