Evaluation of the Achilles Tendon

Abstract

The Achilles tendon often withstands extensive power and is commonly subject to acute ruptures and chronic overuse pathologies. The incidence of Achilles tendon ruptures and Achilles tendinopathy is increasing, and a thorough clinical examination is essential in establishing the diagnosis. To fully recover from Achilles tendon rupture and Achilles tendinopathy, a well-planned rehabilitation programme is necessary. An early diagnosis can therefore help the patient to recover from injury more rapidly. Basic knowledge on the anatomy of the lower leg and a well-executed clinical examination are necessary to establish the diagnosis. The clinical examination of the Achilles tendon consists of inspection and palpation of the Achilles tendon and surrounding tissues. Another part of the examination is passive and active plantar flexion of the foot. For acute injuries and Achilles tendon ruptures, the calf squeeze test and Matles’ test are well acknowledged and useful. The corresponding tests that may be used for chronic overuse syndromes are the “painful arc sign” and the Royal London Hospital test. Even though the clinical examination is considered sufficient, plain radiographs, ultrasonography, and MRI can be of help to establish the diagnosis and deciding on further management of the Achilles tendon injury. There are several patient-reported outcome measurements (PROMs) used in Achilles tendon injury management and rehabilitation. The Achilles tendon total rupture score (ATRS) is commonly used for Achilles tendon ruptures and the Victorian Institute of Sports Assessment-Achilles (VISA-A) for Achilles tendinopathy.