Achilles Tendinopathy – Do I need a scan?

Updated: Mar 9

You don’t need a scan for us to be able to diagnose you with Achilles tendinopathy, but they can be useful. In this article I’ll discuss what a scan can and can’t tell you and when it may be useful to get one.



In this article:

  • How is Achilles tendinopathy diagnosed?

  • What types of scans can be useful

  • What scans can tell you

  • What scans can’t tell you


How is Achilles tendinopathy diagnosed?


Achilles tendinopathy is diagnosed through listening to the patient’s history of how the injury happened as well as where and when they have pain. A group of researchers investigated 10 different clinical tests that are commonly used by clinicians to confirm the diagnosis and they found that the 2 that were the most accurate were also the simplest:

  1. If the patient pointed to the painful area being in the mid tendon.

  2. If you could feel a “swollen” lump in the tendon when you squeezed it.

So you can see that scans aren’t really needed in the first instance.


What types of scans can be useful


X-rays: These are honestly a waste of time. They don’t show soft tissue and can’t be used to diagnose Achilles tendinopathy. Some clinicians order them to look for heel spurs. But there are loads of people with heel spurs that does not have any problems with their Achilles tendons, so I wish people would stop focusing on them.


Ultrasounds scans: These are extremely useful to diagnose Achilles tendinopathy. In tendons with a tendinopathy they can show changes in the tendon structure, you can measure the tendon diameter and check the blood flow (neovascularization). Some ultrasound machines can also measure the stiffness of the tendon, but we’re not quite sure yet of the clinical relevance of this.


MRI scans: These are just as useful and can also show you changes in tendon structure, but you can’t visualise the blood flow.


Which is better, ultrasound or MRI? Both modalities appear to be equally effective in diagnosing Achilles tendinopathy. Ultrasound is much cheaper and can be done in a few minutes. If you consult a skilled sports medicine consultant, they can usually do it for you in their office during the same consultation.



What scans can tell you


  • It can be used to confirm your diagnosis and show the changes in the tendon structure. However, scans can also sometimes show up false positives (where it looks as if the tendon is injured when it’s not) as well as false negatives (where it doesn’t show anything wrong, but actually the tendon is injured).

  • It can show up other things that may be contributing to your problem e.g. a plantaris tendon that is rubbing on the Achilles or a tear in the tendon. That’s why I would always encourage a patient to get a scan if they have been doing all the right things for at least 12 weeks and not seen the results that we expected.


What scans can’t tell you


At the moment, we can’t tell from looking at a scan how bad your injury is or how long it will take for it to get better. There are interesting studies being conducted where they measure tendon stiffness, but at the moment we don’t fully understand how that correlates to your function and recovery. In fact, we don’t yet actually know what should be classed as “normal” tendon stiffness.


Let me know if you have any questions. Need more help with your Achilles injury? You’re welcome to consult us online via video call for an assessment of your injury and a tailored treatment plan.

Best wishes

Maryke


About the Author:

Maryke Louw is a chartered physiotherapist and holds an MSc in Sports Injury Management. You can follow her on LinkedIn, Facebook, Twitter or Instagram.




References:

  1. Aicale, R., et al. (2019). Non-insertional Achilles Tendinopathy: State of the Art. Sports Injuries of the Foot and Ankle, Springer: 359-367.

  2. Borg, M. A., et al. (2016). "Role of ultrasonography in the evaluation of Achilles tendon disorders." Benha Medical Journal 33(1): 54.

  3. Hutchison, A.-M., et al. (2013). "What is the best clinical test for Achilles tendinopathy?" Foot and Ankle Surgery 19(2): 112-117.

  4. Khan, K., et al. (2003). "Are ultrasound and magnetic resonance imaging of value in assessment of Achilles tendon disorders? A two year prospective study." British Journal of Sports Medicine 37(2): 149-153.

  5. McAuliffe, S., et al. (2016). "Can ultrasound imaging predict the development of Achilles and patellar tendinopathy? A systematic review and meta-analysis." Br J Sports Med 50(24): 1516-1523

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