Best clinical test to diagnose achilles tendonitis

Members do not see these Ads. Sign Up.

What is the best clinical test for Achilles tendinopathy?
Anne-Marie Hutchison, Rhodri Evans, Owen Bodger, Ian Pallister, Claire Topliss, Paul Williams, Nicola Vannet, Victoria Morris, David Beard
Foot and Ankle Surgery; Available online 12 February 2013

 

Why oh why you wouldn't diagnostically ultrasound anyway to evaluate for intrasubstance tears is beyond me! Sort of provides conclusive proof to your clinical diagnosis.

 

People like to play the "scatter gun apporoach / guessing game" as that is their habit.
This is common with the "I'll tape you up and see if you feel better (before I treat you)" approach... :dizzy:

Clinical Dx + MSKUS confirmation (reported on by MSK radiologist, not 'garden variety' radiologist), provides a clear & concise Tx plan, with What, Why, How, When...

 

Amen!

 

Here in the USA, MRI is considered the standard of care for Achilles tendon pathology, not diagnostic ultrasound. However, I agree with the authors that learning how to properly palpate the Achilles tendon, in my practice experience, correlates very well to pathology, and is much cheaper and much less time-consuming than either diagnostic ultrasound or MRI.

This all gets back to my recent article in Podiatry Today: Is Manual Examination of the Foot a Dying Art?

 

Kevin - great article. The problem is with advancements in technology must come advancements in clinical investigation. For example 15 years ago it would have been acceptable to say you have achilles tendonitis. Now you may or may not have achilles tendonosis with or without an intrasubstance tear. Technology will always give us the ability to investigate more thoroughly - the real question is whether this more thorough investigation leads to better clinical outcomes and decision making? As the great Dr Karl Landorf always says: "If it isnt going to change the way you treat your patient - why image it!"

 

MSU is more accessible and medicare funded here in Aus. MRI not so much.

The quality of the radiologist and sonographer is really the key in Dx.

In this case, which injectable solution for what type of tendinopathy? The imaging will clarify, as the patient already knows the region is symptomatic / injured.
Can manual / clinical palpation clearly define the pathology?

Obviously the skills / clinical assessment is critical in assessing mechanical reqirements.

In the words of Prof Jill Cooke " you need the right injection for the right (specific) tendinopathy".