Assessment & Diagnosis of Achilles Tendonitis

The following examples are for information purposes only. We highly recommend seeing a sports injury professional or Doctor to receive a full assessment of your injury.

Pain in and around the achilles tendon may arise from a number of structures or conditions and so correct and thorough assessment is necessary for accurate diagnosis. Other conditions to consider include partial or total achilles rupture, retrocalcaneal bursitis, haglunds syndrome and severs disease.

Assessment of any injury should include questions concerning the patients general health, previous injuries and current injury. The aim of these questions is to determine which structure may be causing the pain and what treatment is appropriate. Following this, the therapist will perform a series of tests, often including:

Observation

Observation is usually the first point of any injury assessment. The therapist may observe the patient in several positions:

Standing - to look for fallen arches (flat feet) and other postural complications.
Laying - usually on the front. This can be used to observe the tendon more closely for thickening, redness, swelling and nodules.
Walking and running - to look for overpronation.

Palpation

The therapist should palpate the length of the achilles tendon, from the insertion at the heel, to the junction between the muscle and tendon (approx 1/3 up the calf).
The therapist is looking for any tender points, swelling, nodules or crepitus (creaking).
The calf muscles in general should also be palpated, assessing for tension and any specific tight spots.

Range of Motion

The therapist will usually assess both active and passive range of motion at the ankle joint:

Active range of motion is where the patient moves the ankle through its full range of motion. This should always be compared to the uninjured side and any decreased range or pain should be noted.
Passive range of motion is where the patient relaxes and the therapist moves the ankle. Again this should be compared to the other side, but also to 'normal' movement ranges. A normal range of motion should comfortably allow a 90 degree angle between the lower leg and foot.

Special Tests

Thompson's test for complete tendon rupture.
The therapist squeezes the calf muscles observing for movement at the ankle into plantarflexion (pointing the toes away).
If no movement is seen, suspect a total rupture of achilles tendon

Functional Tests

Assessing the ability to carry out the following tasks gives the therapist a clear picture about the patients current abilities. They can also be used as objective markers to show progression once treatment and rehabilitation have been initiated:

Calf Raise

Single leg calf raise
Assess ability to hop on spot with one leg- only do so if previous tests have not proved conclusive or have not elicited any symptoms.

Additional imaging tests such as ultrasound and MRI may be needed to fully diagnose injury.