Physical examination maneuver
Physical Exam
Achilles Deep Tendon Reflex
also known as Ankle jerk
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Video coming September 2026
How to Perform
With the ankle relaxed, support the forefoot and slightly dorsiflex the ankle (cross the leg over the opposite knee or have the patient kneel on a chair if needed). Strike the Achilles tendon just above its insertion on the calcaneus with the reflex hammer. Compare both sides.
How to Interpret
Showing 6 of 11 findings
Hypothyroidism
Hung-up Achilles reflex
Rule in
Somewhat helpful
Rule out
InconclusiveWide CI
Evidence:Limited
Lumbosacral Radiculopathy
Hyporeflexia (≤1+) at Achilles
Rule in
Not helpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Limited
Peripheral Neuropathy
Lower-extremity bedside cluster positive (≥2 of 3: Achilles reflex absent despite facilitation, vibration <10 seconds at toe with 128-Hz tuning fork, or position sense <8 of 10 1-cm trials at toe)
Rule in
HelpfulDerived CI
Rule out
Very helpfulDerived CI
Evidence:Limited
Multi-level hyporeflexia pattern (all deep tendon reflexes impaired)
Rule in
Very helpfulDerived CI
Rule out
Minimally helpfulDerived CI
Evidence:Limited
Hyporeflexia (≤1+) at Achilles
Rule in
Somewhat helpfulDerived CI
Rule out
HelpfulDerived CI
Evidence:Limited
Lower-extremity hyporeflexia pattern (Achilles + patellar both impaired)
Rule in
Somewhat helpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Limited