Quick answer
Achilles tendinopathy is primarily a clinical diagnosis based on pain location, load-related symptoms and examination. Imaging is useful when the diagnosis is uncertain, symptoms are atypical, a tear or other pathology is suspected, or treatment is not progressing as expected.
Article
Clinical assessment first
Assessment includes symptom location, onset, activity changes, morning stiffness, palpation, calf strength, heel-raise capacity and functional loading. The clinician also looks for features suggesting rupture, bursitis, inflammatory disease or referred pain.
Ultrasound
Ultrasound can assess tendon thickness, echotexture, focal defects, calcification and adjacent structures dynamically. Doppler may show vascularity, but vascularity alone does not define the cause or severity of pain.
X-ray and MRI
X-ray is particularly useful for insertional bony anatomy and calcification. MRI provides broader soft-tissue and bone detail and can be valuable when a partial tear, extensive insertional disease or alternative diagnosis is being considered.
Key points
- Clinical findings and imaging should agree before invasive treatment is planned.
- Ultrasound is useful for real-time tendon assessment and image-guided procedures.
- MRI is not routinely necessary for straightforward mid-substance tendinopathy.
Frequently Asked Questions
Can an ultrasound look abnormal when I have no pain?
Yes. Structural tendon changes can be present in asymptomatic people.
Which scan is best?
It depends on the clinical question. Ultrasound, X-ray and MRI provide different information.