Physical examination and imaging of the achilles tendon

Disorders of the Achilles tendon include degenerative disease, abnormalities of the surrounding tissue, or rupture of the tendon substance or its insertion. Clinical examination of the tendon is sufficient in most cases to allow a diagnosis and therefore guide initial treatment. Multiple signs and symptoms are obvious on inspection and palpation, as well as upon testing of range of motion, motor, and gait ambulation. Moreover, several provocative maneuvers have been described that allow for the prompt, inexpensive diagnosis of tendinopathy or rupture. When further study is needed, the clinician may utilize one of several imaging modalities, including radiography, magnetic resonance imaging, or ultrasound, to further characterize the tendon and surrounding tissues. These modalities provide sensitive soft tissue detail and are particularly helpful in surgical planning. The available literature supports the use of advanced imaging in cases of vague clinical presentation, in subacute or chronic injuries, and when physical examination does not reveal the classic findings of tendinopathy or rupture. This chapter will therefore review the signs and symptoms of Achilles tendon disease evident through physical examination, routine imaging, and advanced imaging.