How we can diagnose and treat your Achilles injury via video call

Are you wondering how physio consultations via video call can work for you and your Achilles injury? Isn’t the physio supposed to poke and prod your injury to get a diagnosis and then massage you to make things better? In this article, I explain how we safely and accurately assess, diagnose, and treat patients with Achilles injuries via video call and what you can expect from such a consultation.

In this article:

1. How we diagnose Achilles injuries via video call

2. How does online treatment work? Don't you have to touch me?

3. What to expect from our video consultations

4. How we can help

I've also made a video about this:

How we diagnose Achilles injuries via video call

We're often asked how we can diagnose an Achilles injury if we're not in the same room as the patient. Don't we have to use our hands to assess it? In truth, touching a patient doesn't add much to the diagnosis.

No single test for diagnosing Achilles injuries is 100% accurate. To make a diagnosis, a physiotherapist or doctor has to combine information from the following:

1. Really listening to the patient. We have an in-depth discussion about how the injury started, how it reacts to different activities during the day, what their medical history is, any medication they may be taking, what sports or activities they are currently doing (including the nature of their job), and what they want to be able to do once they’ve recovered. We allow 45 minutes of consultation time when we see a patient for the first time so that we can really get to grips with their circumstances.

2. Movement tests, e.g. calf raises (going up on your toes) and stretches. These are easily done online; the video feed allows us to demonstrate the movements and observe how the patient performs them.

3. Pressing on the tendon to see if the symptoms that the patient is reporting are actually located on or in the Achilles tendon. We guide our patients to do this themselves.

4. Scans. These are only necessary if the previous three points do not fit the typical picture of a specific Achilles injury or if we suspect that the patient has a serious injury like an Achilles tendon tear.

We always refer patients to their doctor or hospital emergency department if we suspect that they have a serious Achilles injury that requires treatment that we can't safely offer.

How does online treatment work? Don't you have to touch me?

Physiotherapy is incorrectly seen as being mainly massage therapy. Massage can be helpful for short-term pain relief (if it is done correctly), but it will not fix your Achilles injury nor prevent it from returning.

An Achilles injury usually means that your tendon cannot deal with the forces and loads placed on it by your normal daily activities and sport as well as before. The only way to restore a tendon's strength, endurance, and load tolerance is by following an exercise plan that starts at the right level for your specific injury and circumstances and then progresses in line with how the injury is healing and what your end goals are.

We easily and effectively provide these bespoke plans to our patients via video call. More on this below.

Here's a quick summary (with links to articles with more detail) of what treatments work best for the most common Achilles injuries, based on the latest research:

• Achilles tendonitis or tendinopathy: The most up-to-date, evidence-based treatment for Achilles tendonitis or tendinopathy combines load management and exercises to help your tendon regain its lost strength, both of which we can easily provide via video call. You can find an in-depth discussion of the treatments supported by the research and which ones to avoid in this article.

• Partial Achilles tendon tears: Treatment for partial Achilles tears usually consists of a period of protection (wearing an orthopaedic boot or heel lift inserts in shoes) and then careful loading through exercises to strengthen the tendon.

• Complete Achilles tendon tears: Complete Achilles ruptures or tears can be managed conservatively (using a boot) or with surgery (followed by a period in a boot). In both cases, rehab exercises and careful loading of the tendon form the most important part of the recovery process once the boot is removed and your doctor has cleared you to start rehab.

What to expect from our video consultations

These are the steps we follow to ensure an accurate diagnosis and to create a treatment plan that is designed around your needs:

1. We get to understand the history of your problem, exactly as we would do in a clinic, by asking you questions.

2. Following that, we ask you to do a series of tests and movements, and we watch you doing them on-screen. These tests and movements are exactly the same as we use during in-person consultations in a clinic.

3. To see all the areas of your body that we need to assess, we may ask you to move your camera/phone/laptop around. It is best to be in a room with little or no interruptions, like it would be in a clinic, and you will need enough space to sit, stand, and lie down.

4. We demonstrate the rehab exercises we’re prescribing, and then it’s your turn to do them on-screen so we can check that you're doing them correctly.

5. After the appointment, you will receive a report on your injury and what we have discussed during the assessment. This will include your personalised exercise programme with pictures and/or videos and a training/activity plan for the next few weeks.

What you'll need

• A mobile phone, computer (with webcam), tablet, or similar for the video call. It works best if your device can be moved around during the session, e.g. placed on the floor.

• Space to lie, sit, and stand

• Comfortable, loose clothing.

Preferable but not a necessity

• A portable chair, e.g., a dining or desk chair

• Pen and paper

• Some wall space.

Your body is very good at healing itself, including Achilles tendon injuries, as long as you provide the correct environment. Online physio lends itself perfectly to treating Achilles injuries as we help you to help your body do just that with expert advice and a tailor-made exercise prescription.

How we can help

Need help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author:

Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn, Facebook, Instagram, and Twitter.