The diagnosis of most causes of tendinopathy is clinical – based primarily on the history and examination. In most cases, the tendon is readily palpable.

Physical exploration normally reveals a more sensitive area of the tendon with pain during load-bearing activity. Likewise, there is also a loss of muscle volume and strength caused by reflex inhibition (pain protection).

An assessment of the various biomechanical risk factors is important. As outlined earlier, the most common problem is hyper-pronation of the foot. As a result, an assessment for ligamentous laxity of the mid-foot or weakness of the calf muscle is important in Achilles tendinopathy. Other biomechanical issues which should be assessed for in this condition include lateral tibial torsion, tibial varus, pes cavus and asymmetry of the lower limbs.

Click on the following image to view some of the techniques used to examine an injured Achilles tendon.

Palpation is a very useful tool to assess for tendinopathy. An assessment of Achilles tendon length is also very important to exclude tendon rupture.

The most common tendinopathies seen in football involve the Achilles and patellar tendons. These are considered in more detail in the “Ankle” and “Knee ligament” modules respectively.

Dr Mark Fulcher

Sport and Exercise Physician