Achilles tendon rupture — CCFP MCQ

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EasyMusculoskeletal and sportsAchilles tendon ruptureCCFP

A 35-year-old runner has acute posterior heel pain after suddenly sprinting uphill. He felt struck in the calf and now cannot perform a single-leg heel raise. When the examiner squeezes his calf muscles, there is no movement of his foot downward. What is the most likely diagnosis?

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Correct answer: B — Achilles tendon rupture

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · A = shown as D · C = shown as E

The correct answer is **Achilles tendon rupture (D)**. This case presents the classic triad of acute Achilles rupture: (1) sudden onset with sensation of being 'struck' or 'kicked,' (2) inability to perform a single-leg heel raise due to loss of plantarflexion power, and (3) positive Thompson test (calf-squeeze test), where squeezing the calf muscles produces no foot plantarflexion. These findings are pathognomical. The mechanism—sprinting uphill—is also typical. Physical examination alone has high sensitivity and specificity for diagnosis; imaging is reserved for equivocal cases. Plantar fasciitis (A) causes chronic heel pain but does not impair strength or produce a positive Thompson test. Ankle sprain (B) affects lateral ankle stability, not plantarflexion power. Calcaneal stress fracture (C) causes heel pain but would not result in acute loss of function or a positive calf-squeeze test. Tarsal tunnel syndrome (E) presents with gradual onset of paresthesias, not acute loss of strength.

Reference: College of Family Physicians of Canada (CFP). 'Achilles tendon rupture.' Canadian Family Physician, Vol. 59, Issue 6, June 2013. https://www.cfp.ca/content/59/6/647.1; supported by systematic evidence on diagnostic accuracy of Thompson test in PubMed (2019) and Ontario epidemiological data (Sheth et al., 2017).