Achilles Tendinopathy Diagnosis
Diagnosing an Achilles Tendon Injury
A physical exam or with diagnostic tests. To help your doctor achieve a proper diagnosis, he/she will begin with a medical history about you, your current condition and symptoms, the intensity of your pain, the duration of your symptoms and the limitations you are experiencing. Details about what causing the problem, when it started, and whether or not you have ever had treatments (for this or a similar condition in the past) are very helpful in assessing your injury.
Your doctor will visually assess and palpate (feel) the bones and soft tissue in and around both of your Achilles tendons to evaluate symmetry and spot any differences. Such as inflammation, swelling, bone deformity, scar tissue build up, and a weakened tendon. He/she will press on the injured tendon to test for tenderness, tough nodes of scar tissue, and jelly-like sections on the tendon. He/she will probably ask you to push down with the ball of your foot and toes (plantarflexing) to evaluate the flexibility, alignment, range of motion and pain level.
Common Diagnostic Tests for the Achilles Tendon
Diagnostic testing to obtain more detailed information, and assess the amount and/or type of damage done to your Achilles tendon. There are a variety of different tests available to help them analyze the situation; however the recommendation will be dependent on your injury.
The Thompson Test is a common physical exam that doctors use to determine if an Achilles tendon has ruptured.
This test involves the patient lying face down on the exam table with knees at a 90 degree angle. The doctor squeezes the calf muscles of the injured leg. If the foot flexes downward (like trying to point your toes) the Achilles tendon is not torn. If the Achilles tendon is torn, the foot does not move.
X-rays don't show much relative to tendons and other soft tissue but it will provide an image of the overall bone structure of your ankle. It is helpful in identifying bone spurs, calcifications within the tendon, fractures or degeneration of the heel bone.
CAT or CT scans can be used to provide a 3-dimensional assessment of the bones and soft tissues in and around your Achilles tendon and may be used to identify a tendon tear.
MRIs (magnetic resonance imaging) will provide more detailed information and will help to evaluate the Achilles tendon damage. An MRI can diagnose tendinosis, tissue damage and tears, and/or other associated conditions.
The type of test recommended will depend on your symptoms and the opinion of your medical professional.
Treating an Achilles Tendon Injury
Your doctor will give advice to use conservative treatments before even suggesting surgery. It is generally understood by doctors and surgeons, that surgery will introduce more scar tissue into the any already damaged tissue. This added scar tissue will be problematic, requiring more PT and conservative treatment options post-surgery. If not dealt with properly, your tendonitis injury could end up in worse condition than before the surgery! This is why surgery is only performed as a last resort.
Most doctors, surgeons and orthopedic specialists will recommend conservative treatment methods for Achilles Tendon injuries before even considering surgery. Some conservative treatment methods recommended include:
- Rest - This is important for initial recovery for both Midpoint and Insertional Achilles Tendonitis; rest and elevation will help reduce pain, swelling and inflammation in the early stages of injury. This can be difficult when you have to carry on with daily activities, but resting and elevating your foot whenever you can is recommended. During your recovery you will probably have to modify or avoid the activities that put stress on your Achilles tendon until your pain and inflammation settles. Too much rest can also be harmful to achilles injuries because ankle joint immobility can actually cause stiffening in the joint. This is why rest should be used when reducing initial pain and swelling, but should not be considered for more long-term conservative treatment.
- Avoid Activities that Caused Your Injury - While resting your injury it's also important to avoid all activities that may have caused your tissue damage (especially any repetitive movement). Continuing on with regular activities can increase the severity of your injury, turning a mild to moderate case of tendon damage into a downward spiral of worsening damage that may eventually severely impact your life. Also, trying to 'work around' your injury will eventually give rise to over-compensation injuries in other areas of your body.
- Use a Cold Compress or Ice Pack - Cold is very effective at reducing pain and inflammation - use at the onset of the injury and during flareups.
- Use Circulation Boost (T•Shellz Wrap®) - after swelling and inflammation has been reduced. You can use your own blood flow to maximize your rehabilitation, maintain healthy blood flow to your achilles and heel, decrease recovery time, and boost the bodys healing rate. Promoting blood flow to your achilles will help to minimize the growth of scar tissue, increase flexibility and help prevent atrophy.
- Rehabilitative Stretching under supervision of a PT or doctor. The intent of this is to provide you with increased range of motion, pain relief and strengthening of the surrounding tissue of the joint. Doctors or surgeons typically won't perform a surgery until they feel that their patient has put effort into treating their injury with conservative treatment methods. This may include up to 4 to 6 months of visits to a PT clinic. If you haven't experienced any improvement in your condition during that time then surgery may be considered. Agressive PT approaches may focus on forced or manual manipulation of the achilles - this means your physical therapists will be trying to move your achilles past the point of comfort as they strive to increase range of motion and prevent further atrophy. This can be painful and end up making your injury worse if not done correctly. (reference: 1)
- Stretching - Stretching your joint in PT and at home will help you to regain your range of motion much faster than not stretching at all. Stretching in many ways is key maintaining good Range of Motion (ROM) in your joint, and stretching can be made much easier with use of a T•Shellz Wrap® before to warm up soft tissue, and a Cold Compress or Ice Pack treatment after to prevent any return of swelling and inflammation.
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