Diagnosing Achilles Injury

The Achilles is the largest tendon in the body. Tendons are cords of fibrous tissue that connect muscle to bone. The Achilles tendon connects the calf muscle to the bone in the heel and enables you to lift your heel and push down on the ball of the foot and toes as you walk, run, play sports, and engage in other physical activities.

NYU Langone doctors use a physical exam and advanced imaging tests to diagnose injury to the Achilles tendon, including Achilles tendinitis and Achilles rupture.

Causes and Symptoms of Achilles Tendinitis

Overuse of the Achilles, whether through sports or other physical activities such as running, can cause Achilles tendinitis—inflammation in the tendon. Age can also cause the tendons to deteriorate and weaken, contributing to the condition.

Symptoms of Achilles tendinitis can include pain, stiffness, tenderness, and swelling in the heel and along the tendon, especially after physical activity. These symptoms may also be more noticeable when you get out of bed in the morning.

Tendinitis can cause the tendon to weaken further, increasing your risk of Achilles rupture, or tear.

Causes and Symptoms of Achilles Rupture

Achilles rupture, the partial or complete tearing of the tendon, can occur when too much stress is placed on the tendon. People who play sports that require quick pivoting, such as basketball, football, and soccer, are at a higher risk of sustaining this injury. If the tendon is already weakened due to overuse, older age, or tendinitis, then activities such as walking or stepping down can cause a rupture.

Symptoms of an Achilles rupture include pain at the time of injury, swelling, a popping noise as the injury occurs, and the inability to push off your foot properly when you walk.

Physical Exam and Imaging Tests

Our doctors conduct a physical exam and imaging tests to determine whether you have injured your Achilles.

During a physical exam your doctor may ask you about your symptoms and how you sustained your injury. Your doctor can feel the back of your calf and heel, where the tendon is located, to see how inflamed the area is and to determine where the pain is originating.

He or she may also assess your range of motion by asking you to walk or by using what’s called a Thompson test. For this test, you lie face down on an exam table with your feet off the end. The doctor squeezes your calf muscle. If this action does not cause the toes to point downward, the Achilles tendon is likely ruptured.

X-Rays

Your doctor may order an X-ray to create images of the bones in your leg, ankle, and foot and to see whether you have any fractures or bone spurs that are causing pain. Bone spurs are small outgrowths of bone that can irritate the Achilles tendon.

MRI Scans

An MRI scan, which creates images of soft tissues in the body, including muscles and tendons, can help your doctor determine whether you have a partial or complete rupture and find its precise location along the tendon. An MRI can also help determine whether you have other injuries contributing to your symptoms.