Achilles

• Achilles mid portion - Subjective:

  • Pain on Walking / running / hopping / explosive (eases on “warm up”)
  • Gradual – degenerative
  • Sudden – consider partial tear
• Achilles mid portion - Objective

  • Pain over mid portion, about 2 - 6cm above insertion
  • Thickened bump or fusiform
  • Heel raises - test height/number/pain
  • Hops and jumps – pain/inhibition
• Achilles mid portion - Differential diagnosis:

  • Other local tendons/muscles - FHL, FDL, TP, soleus
  • Os trigonum (an extra bone that sometimes develops behind the talus during adolescence) /ankle impingement - posterior ankle pain and reduced plantarflexion
  • Plantaris - compression (medial pain)
  • Lx or nerve referral – tibial, sural
  • Inflammatory arthropathy – needs blood tests
  • Paratenon inflammation – arc sign
• Achilles insertion - Subjective:

  • Similar to mid portion but local pain at insertion +/- swelling (bursa)
• Achilles insertion - Objective:

  • Haglund's deformity - a bony growth on your heel bone (calcaneus) where your Achilles tendon attaches
  • Worse on load from Dorsiflex position (compression)
  • Bent knee calf stretch painful if acute
  • Bent knee heel raise more painful than straight knee
  • Imaging to confirm