Achilles Tendon Injuries and Tendonitis Clinical Presentation

  • Author: Anthony J Saglimbeni, MD; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Jan 18, 2012
 

History

  • Achilles tendon rupture is characterized by an acute onset of pain in the distal rear leg. The patient reports feeling like he or she has been shot, kicked, or cut in the back of the leg, resulting in an inability to ambulate further. A very strong athlete, however, usually is able to overcome that gait abnormality by using other plantar flexors to ambulate normally.
  • Some patients have a history of chronic recurrent calf or Achilles tendon area pain or prior cortisone injection.
  • Achilles tendonitis is seen in jumpers and correlates with the risk factors of increased intensity, participation in a new activity, or new or unsuitable footwear. Injury is observed more commonly in runners, gymnasts, cyclists, and volleyball players; hyperpronation may contribute. In cyclists, a causative factor may be low saddle height, resulting in extra dorsiflexion of the ankle with pedaling.
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Physical

  • Achilles tendon rupture is indicated by obvious leg swelling with a palpable defect in the Achilles tendon. Active plantar flexion is weak or absent. Some strong athletes still may be able to perform toe raises by overcoming the defect with strong peroneals, toe flexors, and posterior tibialis.
  • The Thompson test generally is positive. This test is performed by having the patient lie prone with his knee passively flexed. Squeeze the calf, looking for normal foot plantar flexion. Absence of plantar flexion is considered a positive test. Comparison easily can be made to the uninjured side.
  • In Achilles tendonitis, the area is tender to palpation from 2-5 cm proximal to the calcaneus. Nodules also may be palpable, as well as a "wet leather" sign of crepitation with ankle plantar flexion and dorsiflexion. This is demonstrated by gently squeezing or palpating the Achilles tendon while the athlete or patient actively plantar flexes and dorsiflexes the foot and ankle. The examiner's fingers feel the crepitus as an area of sponginess, as one would expect with "wet leather." Passive ankle dorsiflexion and active resisted plantar flexion may cause increased pain.
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Causes

  • Achilles tendon rupture usually comes after a forced dorsiflexion during active plantar flexion, as with gastrocnemius tears. This is commonly seen in basketball, diving, tennis, and other sports that require forceful push off from the foot. Other predisposing factors include chronic recurrent Achilles tendonitis and prior history of cortisone injections to the Achilles tendon.
  • Achilles tendonitis is seen in jumpers and correlates to risk factors of increased intensity, participation in a new activity, or new or unsuitable footwear. Injury is noted more commonly in runners, gymnasts, cyclists, and volleyball players; hyperpronation may contribute. In cyclists, low saddle height, resulting in extra dorsiflexion of the ankle with pedaling, may be a causative factor.
  • Higher-than-average rates of Achilles rupture have been noted in patients with blood type O, gout, systemic lupus erythematosus, and rheumatoid arthritis.
  • Achilles tendon rupture is seen in patients who are using steroid medication and fluoroquinolone-type antibiotics.
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Contributor Information and Disclosures
Author

Anthony J Saglimbeni, MD  President, South Bay Sports and Preventive Medicine Associates; Private Practice; Team Internist, San Francisco Giants; Team Internist, West Valley College; Team Physician, Bellarmine College Prep; Team Physician, Presentation High School; Team Physician, Santa Clara University; Consultant, University of San Francisco, Academy of Art University, Skyline College, Foothill College, De Anza College

Anthony J Saglimbeni, MD, is a member of the following medical societies: California Medical Association and Santa Clara County Medical Association

Disclosure: South Bay Sports and Preventive Medicine Associates, Inc Ownership interest Other

Coauthor(s)

Christian J Fulmer, DO  Private Practice in Sports and Family Medicine; Team Physician, Valley Christian High School

Christian J Fulmer, DO is a member of the following medical societies: American Academy of Family Physicians, American Academy of Osteopathy, American Medical Society for Sports Medicine, and American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM  President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael T Andary, MD, MS  Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

References

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