Achilles Tendonitis Symptoms and Diagnosis

Achilles palpation - symptoms and diagnosis

Achilles tendonitis symptoms consist of pain and stiffness at the back of the ankle which may have come on suddenly but more often gradually over time.

Symptoms can be either acute, meaning of recent onset and usually more painful, and chronic which will have come on gradually and over weeks or may follow an acute injury that is not treated properly. We recommend seeing a sports injury professional or Doctor to receive a full assessment of your injury.

Acute symptoms

Symptoms of acute Achilles tendonitis will be a gradual onset of pain at the back of the ankle, just above the heel bone which may develop over a period of days. The Achilles tendon may be painful and stiff at the start of exercise and first thing in the morning.

As the tendon warms up the pain will go often for it to return later in the day or towards the end of a prolonged training session. The tendon will be very tender on palpation (feeling / pressing in) of the achilles tendon or squeezing it from the sides. There may be a nodule or lump felt in the middle of the achilles tendon.

Chronic symptoms

Chronic injuries may follow on from acute Achilles tendonitis symptoms if it goes untreated or is not allowed sufficient rest. Chronic achilles tendinosis is a difficult condition to treat, particularly in older athletes who appear to suffer more often. There will be a gradual onset of Achilles tendon pain over a period of weeks, or even months. The pain will come on during exercise and is constant throughout the training session. Pain will be felt in the tendon when walking especially up hill or up stairs because the achilles has to stretch further than normal.

Chronic injuries do not not necessarily prevent activity but can niggle away affecting performance. An MRI or Ultrasound scan can determine the extent of the injury and indicate a precise diagnosis.

The VISA achilles tendon pain questionnaire has been designed to measure progress during rehabilitation. The athlete simply answers a number of questions and their score can give an estimate of how bad the injury is.

Achilles tendon assessment

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 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.

Thompson's test for complete tendon rupture is where 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:

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.

How bad is my achilles pain?

Download a pdf version of the achilles pain questionnaire developed at the Victorian Institute of Sports Assessment:

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: