Differential diagnoses
An achillodynia can quickly be confused with the following symptoms and diseases (differential diagnoses)
Symptoms
In early forms of achillodynia, there is a classic initial pain at the beginning of the corresponding movement. The pain is localized in the area of the Achilles tendon and is sometimes described as pulling upwards. The pain increasingly disappears with longer strain.
- In the early stages, pressure pain is mainly found in the area of the Achilles tendon, independent of any movement. – In advanced stages, pain at rest can already occur. The Achilles tendon thickens during walking and this thickening alone causes additional movement-related pain.
The thickening is usually then also palpable. Accompanying to the pain it can come also to movement impairments. – In late stages, there is almost always a permanent pain under stress.
Those affected usually describe the pain as diffuse, i.e. not limited to one point and ranging from dull to stabbing. Likewise, the distal part of the tendon, i.e. the part located close to the heel, may be thickened and swollen and the tendon is no longer able to move against the underlying tissue, which would be possible with a healthy tendon. In a long lasting achillodynia, where small injuries of the tendon heal by the formation of scar tissue, the thickening of the tendon can develop into a knot, which can then even be felt from the outside.
When the foot is moved, an achillodynia can sometimes even be heard in the form of a rubbing sound, so-called crepitations, or the friction can be felt. Furthermore, the movements that are performed with the help of the Achilles tendon can be difficult and painful to perform during an Achillodynia. The movement sequences affected by this are in particular tiptoeing, running and jumping.
These movements are caused by the contraction of the calf muscles by transferring the resulting force to the foot bones via the Achilles tendon. But passive movement of the Achilles tendon, i.e. its stretching, also causes pain in Achillodynia, for example when walking on the heels of the feet or when pulling the toes towards the tip of the nose. Achillodynia is often accompanied by pressure pain over the affected tendon.
This means that pain can also be caused by external pressure on the tendon. Furthermore, there is sometimes also reddening and overheating of the skin above the Achilles tendon, which is due to a possible inflammation following the wear and tear of the tendon. In contrast to acute damage to the Achilles tendon, where the pain is so severe within a very short time that the person affected can no longer walk, Achillodynia is a degenerative disease.
In this case, age-related wear and tear, but much more frequently in athletes due to overloading or years of incorrect strain on the tendon, causes minor injuries to the tendon, resulting in its wear and tear. Since usually only one Achilles tendon is affected, the Achillodynia typically occurs on one side only. In rare cases, both tendons can also be affected by Achillodynia.
Since the occurrence of Achillodynia can be assigned to a special patient clientele, a precise questioning and examination is of great importance: patient survey: In this case, the patient should be specifically asked about the period of time when the pain occurs and whether corresponding sports are practiced in the form of competitive sports. Especially ball sports and athletics are particularly indicative of a corresponding degenerative process. Physical examination: First the Achilles tendon is palpated while the leg is relieved.
If a movement-independent pressure pain occurs above the heel bone, it can be assumed that the Achillodynia is at a rather earlier stage. If the entire Achilles tendon is already spindle-shaped thickened and pasty swollen (especially after sports activities), one speaks of an advanced stage. The examination of the worn shoes can give indications of a malposition of the feet and legs.
Ultrasound is initially used as the imaging method. It provides various indications of the presence of Achillodynia: in most cases, an X-ray can only show the Achilles tendon if a certain calcification has already begun. However, with the help of the X-ray image, causes that could lead to secondary Achillodynia can be identified or excluded.
In addition, an MRI of the Achilles tendon can be performed, in which the tendon, muscles and bone can be displayed and assessed in parallel. If all diagnostic procedures do not yield a result, consideration must be given to initiating a laboratory chemical examination to determine cholesterol and other blood lipids. – Besides a thickened Achilles tendon (thicker than 5 mm)
