Sections

Workup

Approach Considerations

Laboratory studies usually are not necessary in evaluating and diagnosing an Achilles tendon rupture or injury, although evaluation may help to rule out some of the other possibilities in the differential diagnosis. These laboratory tests, all of which are normal in Achilles tendinosis, include the following:

Complete blood count (CBC) with differential
Coagulopathy panel
Erythrocyte sedimentation rate
Arthritis panel

Imaging studies can aid in the diagnosis and evaluation of Achilles tendon pathology, but typically they are not needed. Like laboratory studies, however, they can be helpful in evaluating possibilities in the differential diagnosis and should be ordered as clinically indicated.

Plain radiography

Radiography may reveal tendon calcifications in tendinosis or spurs at the calcaneal insertion site, but neither is diagnostic for Achilles tendinosis.

Radiographs are more useful for ruling out other injuries than for ruling in Achilles tendon ruptures. The bones appear normal in patients with a ruptured Achilles tendon, although soft tissue swelling may be evident.^[55]

Radiographs of the tibia and fibula often are indicated when the patient’s history shows trauma that may have resulted in fracture of these long bones. Radiographs of the knee and ankle may help to discover findings of degenerative or inflammatory arthropathies.

Ultrasonography

Ultrasonography of the leg and thigh can help to evaluate the possibility of deep venous thrombosis and also can be used to rule out a Baker cyst. Moreover, in experienced hands, ultrasonography can identify a ruptured Achilles tendon or the signs of tendinosis.

Unlike magnetic resonance imaging (MRI), ultrasonography cannot distinguish a partial tear from tendinosis.

In a small study, De Zordo et al concluded that, in terms of revealing the characteristics of Achilles tendinosis, the ultrasonographic technique known as sonoelastography was comparable to clinical examination and ultrasonography only in the identification of distinct softening of the Achilles tendon. However, very early changes in tissue elasticity in Achilles tendinosis may cause mild softening, which should be assessed in follow-up studies.^[56]

MRI

MRI can facilitate definitive diagnosis of a disrupted tendon. This is especially useful when considering the possibility of partial disruption of the Achilles tendon. Partial disruption often is undetectable clinically and may be misdiagnosed as simple Achilles tendinosis; however, partial Achilles disruption often responds to surgical intervention. Imaging the knee can confirm a Baker cyst, as well as the probable underlying pathology causing the Baker cyst.^[57]

MRI can also distinguish between paratenonitis, tendinosis, and bursitis.^[55]In paratenonitis, MRI can reveal fluid in and around the tendon, while in chronic paratenonitis, the paratenon may be seen as thickened and fibrotic.

In tendinosis, increased MRI signal is evident in the tendon and degenerative changes, and partial tears may occasionally be seen. Keep in mind that these MRI findings may also be present in asymptomatic individuals.

Treatment & Management

Albers D, Hoke B. Techniques in Achilles tendon rehabilitation. Tech Foot Ankle Surg. 2003. 2(3):208-19.
Asplund CA, Best TM. Achilles tendon disorders. BMJ. 2013 Mar 12. 346:f1262. [Medline].
Lopez RG, Jung HG. Achilles tendinosis: treatment options. Clin Orthop Surg. 2015 Mar. 7 (1):1-7. [Medline]. [Full Text].
Chan AP, Chan YY, Fong DT, Wong PY, Lam HY, Lo CK, et al. Clinical and biomechanical outcome of minimal invasive and open repair of the Achilles tendon. Sports Med Arthrosc Rehabil Ther Technol. 2011 Dec 20. 3(1):32. [Medline].
Nilsson-Helander K, Silbernagel KG, Thomeé R, Faxén E, Olsson N, Eriksson BI, et al. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med. 2010 Nov. 38(11):2186-93. [Medline].
Khan RJ, Fick D, Keogh A, Crawford J, Brammar T, Parker M. Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 2005 Oct. 87(10):2202-10. [Medline].
Childress MA, Beutler A. Management of chronic tendon injuries. Am Fam Physician. 2013 Apr 1. 87(7):486-90. [Medline].
Wiegerinck JI, Kerkhoffs GM, van Sterkenburg MN, Sierevelt IN, van Dijk CN. Treatment for insertional Achilles tendinopathy: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2013 Jun. 21(6):1345-55. [Medline].
Stevens M, Tan CW. Effectiveness of the Alfredson protocol compared with a lower repetition-volume protocol for midportion Achilles tendinopathy: a randomized controlled trial. J Orthop Sports Phys Ther. 2014 Feb. 44(2):59-67. [Medline].
Moore KL. Clinically Oriented Anatomy. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999.
Kader D, Saxena A, Movin T, Maffulli N. Achilles tendinopathy: some aspects of basic science and clinical management. Br J Sports Med. 2002 Aug. 36(4):239-49. [Medline]. [Full Text].
Aström M, Westlin N. Blood flow in chronic Achilles tendinopathy. Clin Orthop Relat Res. 1994 Nov. 166-72. [Medline].
Aström M, Westlin N. Blood flow in the human Achilles tendon assessed by laser Doppler flowmetry. J Orthop Res. 1994 Mar. 12(2):246-52. [Medline].
Carr AJ, Norris SH. The blood supply of the calcaneal tendon. J Bone Joint Surg Br. 1989 Jan. 71(1):100-1. [Medline].
Gaida J, Alfredson H, Forsgren S, Cook J. Decreased tumour necrosis factor alpha (tnf-a) in serum of patients with achilles tendinopathy: further evidence against the role of inflammation in the chronic stage. Br J Sports Med. 2014 Apr. 48(7):597. [Medline].
Keene JS. Tendon injuries of the foot and ankle. DeLee JC, Drez D, eds. Orthopaedic Sports Medicine. Philadelphia, Pa: WB Saunders; 1994. 1788-94.
Saltzman C, Bonar S. Tendon problems of the foot and ankle. Lutter LD, Mizel MS, Pfeffer GB, eds. Orthopaedic Knowledge Update: Foot and Ankle. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1994. 236-73.
Wheaton MT, Molnar TJ. Overuse injuries of the lower extremities. Griffin, LY, ed. Orthopaedic Knowledge Update: Sports Medicine. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1994. 225-7.
De Jonge S, Warnaars JL, De Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, et al. Relationship between neovascularization and clinical severity in Achilles tendinopathy in 556 paired measurements. Scand J Med Sci Sports. 2013 Apr 22. [Medline].
Schepsis AA, Jones H, Haas AL. Achilles tendon disorders in athletes. Am J Sports Med. 2002 Mar-Apr. 30(2):287-305. [Medline].
Kannus P, Józsa L. Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am. 1991 Dec. 73(10):1507-25. [Medline].
Yuan J, Wang MX, Murrell GA. Cell death and tendinopathy. Clin Sports Med. 2003 Oct. 22(4):693-701. [Medline].
Józsa L, Kannus P. Histopathological findings in spontaneous tendon ruptures. Scand J Med Sci Sports. 1997 Apr. 7(2):113-8. [Medline].
Maffulli N, Barrass V, Ewen SW. Light microscopic histology of achilles tendon ruptures. A comparison with unruptured tendons. Am J Sports Med. 2000 Nov-Dec. 28(6):857-63. [Medline].
Zanetti M, Metzdorf A, Kundert HP, Zollinger H, Vienne P, Seifert B, et al. Achilles tendons: clinical relevance of neovascularization diagnosed with power Doppler US. Radiology. 2003 May. 227(2):556-60. [Medline].
Ohberg L, Alfredson H. Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis?. Knee Surg Sports Traumatol Arthrosc. 2004 Sep. 12(5):465-70. [Medline].
Alfredson H, Ohberg L, Forsgren S. Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis? An investigation using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. Knee Surg Sports Traumatol Arthrosc. 2003 Sep. 11(5):334-8. [Medline].
Cetti R, Junge J, Vyberg M. Spontaneous rupture of the Achilles tendon is preceded by widespread and bilateral tendon damage and ipsilateral inflammation: a clinical and histopathologic study of 60 patients. Acta Orthop Scand. 2003 Feb. 74(1):78-84. [Medline].
Harries M. Oxford textbook of Sports Medicine. 2nd ed. New York, NY: Oxford University Press; Chapt 4.4.3.
Maffulli N, Ewen SW, Waterston SW, Reaper J, Barrass V. Tenocytes from ruptured and tendinopathic achilles tendons produce greater quantities of type III collagen than tenocytes from normal achilles tendons. An in vitro model of human tendon healing. Am J Sports Med. 2000 Jul-Aug. 28(4):499-505. [Medline].
Whittaker P, Canham PB. Demonstration of quantitative fabric analysis of tendon collagen using two-dimensional polarized light microscopy. Matrix. 1991 Feb. 11(1):56-62. [Medline].
Kvist M. Achilles tendon injuries in athletes. Sports Med. 1994 Sep. 18(3):173-201. [Medline].
Scott RT, Hyer CF, Granata A. The correlation of Achilles tendinopathy and body mass index. Foot Ankle Spec. 2013 Aug. 6(4):283-5. [Medline].
Van Ginckel A, Thijs Y, Hesar NG, Mahieu N, De Clercq D, Roosen P, et al. Intrinsic gait-related risk factors for Achilles tendinopathy in novice runners: a prospective study. Gait Posture. 2009 Apr. 29(3):387-91. [Medline].
Hofmann GO, Weber T, Lob G. [Tendon rupture in chronic kidney insufficiency--"uremic tendonopathy"? A literature-supported documentation of 3 cases]. Chirurg. 1990 Jun. 61(6):434-7. [Medline].
Spencer JD. Spontaneous rupture of tendons in dialysis and renal transplant patients. Injury. 1988 Mar. 19(2):86-8. [Medline].
Jozsa L, Balint JB, Kannus P, Reffy A, Barzo M. Distribution of blood groups in patients with tendon rupture. An analysis of 832 cases. J Bone Joint Surg Br. 1989 Mar. 71(2):272-4. [Medline].
Kujala UM, Järvinen M, Natri A, Lehto M, Nelimarkka O, Hurme M, et al. ABO blood groups and musculoskeletal injuries. Injury. 1992. 23(2):131-3. [Medline].
Kraemer R, Wuerfel W, Lorenzen J, Busche M, Vogt PM, Knobloch K. Analysis of hereditary and medical risk factors in Achilles tendinopathy and Achilles tendon ruptures: a matched pair analysis. Arch Orthop Trauma Surg. 2012 Jun. 132(6):847-53. [Medline].
Shrier I, Matheson GO, Kohl HW 3rd. Achilles tendonitis: are corticosteroid injections useful or harmful?. Clin J Sport Med. 1996 Oct. 6(4):245-50. [Medline].
Newnham DM, Douglas JG, Legge JS, Friend JA. Achilles tendon rupture: an underrated complication of corticosteroid treatment. Thorax. 1991 Nov. 46(11):853-4. [Medline]. [Full Text].
Malaguti M, Triolo L, Biagini M. Ciprofloxacin-associated Achilles tendon rupture in a hemodialysis patient. J Nephrol. 2001 Sep-Oct. 14(5):431-2. [Medline].
Harrell RM. Fluoroquinolone-induced tendinopathy: what do we know?. South Med J. 1999 Jun. 92(6):622-5. [Medline].
Diehl J. Platelet-rich plasma therapy in chronic Achilles tendinopathy. Tech Foot Ankle Surg. March 2011. 10(1):2-6.
Malliou P, Rokka S, Beneka A, Gioftsidou A, Mavromoustakos S, Godolias G. Analysis of the chronic lower limb injuries occurrence in step aerobic instructors in relation to their working step class profile - A three year longitudinal prospective study. J Back Musculoskelet Rehabil. 2014 Feb 20. [Medline].
Maffulli N, Longo UG, Maffulli GD, Khanna A, Denaro V. Achilles tendon ruptures in elite athletes. Foot Ankle Int. 2011 Jan. 32(1):9-15. [Medline].
Arøen A, Helgø D, Granlund OG, Bahr R. Contralateral tendon rupture risk is increased in individuals with a previous Achilles tendon rupture. Scand J Med Sci Sports. 2004 Feb. 14(1):30-3. [Medline].
Almekinders LC, Weinhold PS, Maffulli N. Compression etiology in tendinopathy. Clin Sports Med. 2003 Oct. 22(4):703-10. [Medline].
Aström M. Partial rupture in chronic achilles tendinopathy. A retrospective analysis of 342 cases. Acta Orthop Scand. 1998 Aug. 69(4):404-7. [Medline].
Hutchison AM, Evans R, Bodger O, Pallister I, Topliss C, Williams P, et al. What is the best clinical test for Achilles tendinopathy?. Foot Ankle Surg. 2013 Jun. 19(2):112-7. [Medline].
de Jonge S, van den Berg C, de Vos RJ, van der Heide HJ, Weir A, Verhaar JA, et al. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med. 2011 Oct. 45(13):1026-8. [Medline].
Saxena A, Ewen B, Maffulli N. Rehabilitation of the operated achilles tendon: parameters for predicting return to activity. J Foot Ankle Surg. 2011 Jan-Feb. 50(1):37-40. [Medline].
Westin O, Nilsson Helander K, Gravare Silbernagel K, Samuelsson K, Brorsson A, Karlsson J. Patients with an Achilles tendon re-rupture have long-term functional deficits in function and worse patient-reported outcome than primary ruptures. Knee Surg Sports Traumatol Arthrosc. 2018 Apr 24. [Medline].
Jildeh TR, Okoroha KR, Marshall NE, Abdul-Hak A, Zeni F, Moutzouros V. Infection and Rerupture After Surgical Repair of Achilles Tendons. Orthop J Sports Med. 2018 May. 6 (5):2325967118774302. [Medline]. [Full Text].
Tonarelli JM, Mabry LM, Ross MD. Diagnostic imaging of an Achilles tendon rupture. J Orthop Sports Phys Ther. 2011 Nov. 41(11):904. [Medline].
De Zordo T, Chhem R, Smekal V, Feuchtner G, Reindl M, Fink C, et al. Real-time sonoelastography: findings in patients with symptomatic achilles tendons and comparison to healthy volunteers. Ultraschall Med. 2010 Aug. 31(4):394-400. [Medline].
Juras V, Zbyn S, Pressl C, Domayer SE, Hofstaetter JG, Mayerhoefer ME, et al. Sodium MR Imaging of Achilles Tendinopathy at 7 T: Preliminary Results. Radiology. 2012 Jan. 262(1):199-205. [Medline].
McCormack R, Bovard J. Early functional rehabilitation or cast immobilisation for the postoperative management of acute Achilles tendon rupture? A systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2015 Oct. 49 (20):1329-35. [Medline].
Grigg NL, Stevenson NJ, Wearing SC, et al. Incidental walking activity is sufficient to induce time-dependent conditioning of the Achilles tendon. Gait Posture. 2009 Oct 5. [Medline].
Henriksen M, Aaboe J, Bliddal H, et al. Biomechanical characteristics of the eccentric Achilles tendon exercise. J Biomech. 2009 Sep 21. [Medline].
Gardin A, Movin T, Svensson L, et al. The long-term clinical and MRI results following eccentric calf muscle training in chronic Achilles tendinosis. Skeletal Radiol. 2009 Sep 23. [Medline].
Hawkins D, Lum C, Gaydos D, et al. Dynamic creep and pre-conditioning of the Achilles tendon in-vivo. J Biomech. 2009 Sep 15. [Medline].
Maempel JF, Clement ND, Wickramasinghe NR, Duckworth AD, Keating JF. Operative repair of acute Achilles tendon rupture does not give superior patient-reported outcomes to nonoperative management. Bone Joint J. 2020 Jul. 102-B (7):933-40. [Medline].
Ecker TM, Bremer AK, Krause FG, Muller T, Weber M. Prospective Use of a Standardized Nonoperative Early Weightbearing Protocol for Achilles Tendon Rupture: 17 Years of Experience. Am J Sports Med. 2016 Apr. 44 (4):1004-10. [Medline].
Cohen RS, Balcom TA. Current treatment options for ankle injuries: lateral ankle sprain, Achilles tendonitis, and Achilles rupture. Curr Sports Med Rep. 2003 Oct. 2(5):251-4. [Medline].
Alfredson H, Pietilä T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998 May-Jun. 26(3):360-6. [Medline].
Rees JD, Lichtwark GA, Wolman RL, Wilson AM. The mechanism for efficacy of eccentric loading in Achilles tendon injury; an in vivo study in humans. Rheumatology (Oxford). 2008 Oct. 47(10):1493-7. [Medline].
Reese RC Jr, Burruss TP, Patten J. Athletic training techniques and protective equipment. Nicholas JA, Hershman EB, eds. The Lower Extremity & Spine in Sports Medicine. 2nd ed. St Louis, Mo: Mosby; 1995. 267-75.
Marsolais D, Côté CH, Frenette J. Nonsteroidal anti-inflammatory drug reduces neutrophil and macrophage accumulation but does not improve tendon regeneration. Lab Invest. 2003 Jul. 83(7):991-9. [Medline].
Ohberg L, Alfredson H. Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment. Br J Sports Med. 2002 Jun. 36(3):173-5; discussion 176-7. [Medline]. [Full Text].
Clementson M, Lorén I, Dahlberg L, Aström M. Sclerosing injections in midportion Achilles tendinopathy: a retrospective study of 25 patients. Knee Surg Sports Traumatol Arthrosc. 2008 Sep. 16(9):887-90. [Medline].
de Jonge S, de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, et al. One-year follow-up of platelet-rich plasma treatment in chronic Achilles tendinopathy: a double-blind randomized placebo-controlled trial. Am J Sports Med. 2011 Aug. 39(8):1623-9. [Medline].
Mautner K, Colberg RE, Malanga G, Borg-Stein JP, Harmon KG, Dharamsi AS, et al. Outcomes after ultrasound-guided platelet-rich plasma injections for chronic tendinopathy: a multicenter, retrospective review. PM R. 2013 Mar. 5(3):169-75. [Medline].
Di Matteo B, Filardo G, Kon E, Marcacci M. Platelet-rich plasma: evidence for the treatment of patellar and Achilles tendinopathy--a systematic review. Musculoskelet Surg. 2015 Apr. 99 (1):1-9. [Medline].
Paoloni JA, Appleyard RC, Nelson J, Murrell GA. Topical glyceryl trinitrate treatment of chronic noninsertional achilles tendinopathy. A randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am. 2004 May. 86-A(5):916-22. [Medline].
Fox A, Murrell G. Nitric oxide and tendon healing. Tech Orthoped. 2007. 22(1):14-9.
Al-Abbad H, Simon JV. The effectiveness of extracorporeal shock wave therapy on chronic achilles tendinopathy: a systematic review. Foot Ankle Int. 2013 Jan. 34(1):33-41. [Medline].
Rompe JD, Furia J, Maffulli N. Eccentric loading versus eccentric loading plus shock-wave treatment for midportion achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2009 Mar. 37(3):463-70. [Medline].
McLaughian GJ, Handol HG. Interventions for treating acute and chronic Achilles tendinitis. (Cochrane review). The Cochrane Library,. Chichester, UK: John Wiley and Sons; Issue 1:
Brosseau L, Casimiro L, Milne S, Robinson V, Shea B, Tugwell P, et al. Deep transverse friction massage for treating tendinitis. Cochrane Database Syst Rev. 2002. CD003528. [Medline].
Zhang BM, Zhong LW, Xu SW, Jiang HR, Shen J. Acupuncture for chronic Achilles tendnopathy: a randomized controlled study. Chin J Integr Med. 2013 Dec. 19(12):900-4. [Medline].
Wegrzyn J, Luciani JF, Philippot R, et al. Chronic Achilles tendon rupture reconstruction using a modified flexor hallucis longus transfer. Int Orthop. 2009 Aug 21. [Medline].
Metz R, Verleisdonk EJ, van der Heijden GJ, Clevers GJ, Hammacher ER, Verhofstad MH, et al. Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing--a randomized controlled trial. Am J Sports Med. 2008 Sep. 36(9):1688-94. [Medline].
Twaddle BC, Poon P. Early motion for Achilles tendon ruptures: is surgery important? A randomized, prospective study. Am J Sports Med. 2007 Dec. 35(12):2033-8. [Medline].
Keller A, Ortiz C, Wagner E, Wagner P, Mococain P. Mini-Open Tenorrhaphy of Acute Achilles Tendon Ruptures: Medium-Term Follow-up of 100 Cases. Am J Sports Med. 2014 Mar. 42(3):731-6. [Medline].
Wilkins R, Bisson LJ. Operative versus nonoperative management of acute Achilles tendon ruptures: a quantitative systematic review of randomized controlled trials. Am J Sports Med. 2012 Sep. 40(9):2154-60. [Medline].
Erickson BJ, Mascarenhas R, Saltzman BM, et al. Is Operative Treatment of Achilles Tendon Ruptures Superior to Nonoperative Treatment?: A Systematic Review of Overlapping Meta-analyses. Orthop J Sports Med. 2015 Apr. 3 (4):2325967115579188. [Medline]. [Full Text].
Amendola A. Outcomes of open surgery versus nonoperative management of acute achilles tendon rupture. Clin J Sport Med. 2014 Jan. 24(1):90-1. [Medline].
DeLee JC, Drez D Jr, Miller MD, eds. Orthopaedic Sports Medicine. 2nd ed. Philadelphia, Pa: WB Saunders; 2003.
Pajala A, Kangas J, Siira P, Ohtonen P, Leppilahti J. Augmented compared with nonaugmented surgical repair of a fresh total Achilles tendon rupture. A prospective randomized study. J Bone Joint Surg Am. 2009 May. 91(5):1092-100. [Medline].
Rahm S, Spross C, Gerber F, Farshad M, Buck FM, Espinosa N. Operative treatment of chronic irreparable Achilles tendon ruptures with large flexor hallucis longus tendon transfers. Foot Ankle Int. 2013 Aug. 34(8):1100-10. [Medline].
Silbernagel KG, Nilsson-Helander K, Thomee R, et al. A new measurement of heel-rise endurance with the ability to detect functional deficits in patients with Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc. 2009 Aug 19. [Medline].
Maquirriain J, Kokalj A. Acute Achilles tendinopathy: effect of pain control on leg stiffness. J Musculoskelet Neuronal Interact. 2014 Mar. 14(1):131-6. [Medline].

Media Gallery

of 0

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, Santa Clara County Medical Association, Monterey County Medical Society

Disclosure: Received ownership interest from South Bay Sports and Preventive Medicine Associates, Inc for board membership.

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, American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Dean H Hommer, MD Chief Medical Officer, William Beaumont Army Medical Center

Dean H Hommer, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Healthcare Executives, American Association for Physician Leadership, American Society of Regional Anesthesia and Pain Medicine

Disclosure: Nothing to disclose.

Acknowledgements

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

Edward Behn, MBBS, MRCS

Disclosure: Nothing to disclose.

David T Bernhardt, MD Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics/Ortho and Rehab, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health

David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Jason H Calhoun, MD, FACS Department Chief, Musculoskeletal Sciences, Spectrum Health Medical Group

Jason H Calhoun, MD, FACS, is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association

Disclosure: Biocomposite Grant/research funds Other

James K DeOrio, MD Associate Professor of Orthopedic Surgery, Duke University School of Medicine

James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Foot and Ankle Society

Disclosure: Merete Royalty Other; SBi Royalty Other; BioPro Royalty Other; Acumed, LLC Honoraria Speaking and teaching; Wright Medical Technology, Inc Honoraria Speaking and teaching; SBI Honoraria Speaking and teaching; Integra Speaking and teaching; Datatrace Publishing Honoraria Speaking and teaching; Exactech, Inc Honoraria Speaking and teaching; Tornier Honoraria Speaking and teaching

Kevin J Eerkes, MD Clinical Assistant Professor, Department of Medicine, New York University School of Medicine; Medical Team Physician, New York University Athletics

Disclosure: Nothing to disclose.

Laura M Gottschlich, DO Assistant Professor of Family and Community Medicine and Orthopedic Surgery, Medical College of Wisconsin; Consulting Staff, Family Medicine Residency Program, All Saints Hospital, Wheaton Franciscan Healthcare

Laura M Gottschlich, DO is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Association, American Medical Society for Sports Medicine, and American Osteopathic Association

Disclosure: Nothing to disclose.

Richard Hargrove, MBBS, FRCS(Ire), FRCS Consulting Staff, Hip and Hip Revision Arthroplasty, Frimley Park Hospital

Richard Hargrove, MBBS, FRCS(Ire), FRCS is a member of the following medical societies: Royal College of Surgeons of England and Royal Society of Medicine

Disclosure: Nothing to disclose.

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Biomet, Inc. Consulting fee Consulting; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

Shepard R Hurwitz, MD Executive Director, American Board of Orthopaedic Surgery

Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Brian A Jacobs, MD, FACSM Consulting Staff, Private Practice, Family Medicine of South Bend; Team Physician, Marian High School

Brian A Jacobs, MD, FACSM is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

David Y Lin, MD Fellow, Department of Orthopedic Surgery, Section of Pediatrics, University of Tennessee Campbell Clinic

David Y Lin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Henry Marano, MD Director, Department of Orthopedic Surgery, Associate Professor, St Joseph's Hospital, Albert Einstein College of Medicine

Henry Marano is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Chris McLean, MBBS, MRCS(Glasg), AFRCS(Ire) Specialist Registrar, Departments of Orthopedic and Trauma Surgery, Frimley Park Hospital, UK

Chris McLean, MBBS, MRCS(Glasg), AFRCS(Ire) is a member of the following medical societies: British Medical Association

Disclosure: Nothing to disclose.

Evan Schwartz, MD Director of Orthopedic Surgery, New York Medical College; Assistant Professor, St John's Queens Hospital, Department of Surgery, Albert Einstein School of Medicine

Evan Schwartz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine

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

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.

Achilles Tendon Injuries Workup

Approach Considerations

Imaging Studies

Plain radiography

Ultrasonography

MRI

About

Membership

Apps

WebMD Network

Editions

Achilles Tendon Injuries Workup

Approach Considerations

Imaging Studies

Plain radiography

Ultrasonography

MRI

References

Tables

Contributor Information and Disclosures

What would you like to print?

Find Us On

About

Membership

Apps

WebMD Network

Editions