A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes.
- Gait (fluid, limping).
- Body or joint posture (upright, bent, gentle posture).
- Malpositions (deformities, contractures, shortenings).
- Muscle atrophies (side comparison!, if necessary circumference measurements).
- Joint (abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation, arthritic joint lumpiness, leg axis assessment).
- Palpation (palpation) of hindfoot and forefoot; prominent bone points, ligaments; musculature (tension of calf muscles in lateral comparison with slightly bent knees); joint (joint effusion?); soft tissue swelling.
- Palpation of the Achilles tendon:
- Tenderness: localization two to six centimeters above the calcaneal Achilles tendon insertion.
- Spindle-shaped thickening of the Achilles tendon after a longer course (characteristic).
- Doughy tactile sensation indicates activation of the disease
- Firm consistency of the tendon indicates a healed or compensated condition
- Check sensation of pain:
- Pincer grip: the Achilles tendon is taken between two fingers. The patient lies on the abdomen while doing this. (Crepitation / audible and palpable crackling sounds?).
- Toe stand pain-free possible?
- Pain with passive stretching of the Achilles tendon (heel walk)?
- Inspection (viewing).
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
