Achilles Tendon Problems Often Misdiagnosed: Study

New research suggests that about one quarter of all Achilles tendon ruptures are misdiagnosed during an initial examination with a doctor, often resulting in delayed therapeutic treatment and increasing the risk of long term problems. 

In a study published earlier this month in The Journal of the American Osteopathic Association, researchers from the Rowan University School of Osteopathic Medicine and the Rothman Institute of Jefferson Medical College indicated that about 25% of initial examinations misdiagnose Achilles tendon problems, including ruptures or tears.

The Achilles is the largest tendon in the human body, connecting the muscles at the back of the lower leg to the heel. This muscles is essential for walking, running, jumping and mostly any activity that involves being on your feet.

Problems with the Achilles tendon can be extremely painful, with walking or pressure applied to the ruptured area potentially resulting in the need for surgery or causing long term damage that may lead to the need for long-term assisted walking devices.

Researchers found that Achilles tendon disorders are often not diagnosed during initial evaluations by doctors due to a broad range of similar and more common injuries sustained to the lower extremities, resulting in a failure to diagnose Achilles tendon problems.

The study reveals that roughly 25% of initial examinations misdiagnose lower leg pain and are not identified until the results of the magnetic resonance imaging (MRI) are received and reviewed.

Researchers attribute the misdiagnoses to a failure to give lower musculoskeletal examinations, and doctors only requiring MRI or ultrasound imaging for patients who are perceived to have ruptured tendons.

This time lapse often causes injuries to the Achilles tendon to worsen, since common therapeutic treatment calls for rest, ice, activity modification, and nonsteroidal anti-inflammatory drugs.

Dr. Joseph Daniel, Professor of Orthopedic Surgery at the Jefferson Medical College recommended in the study that detailed musculoskeletal examinations of the lower extremities should always be performed. Specifically, Daniels stated doctors should focus their attention to the heel area to check for swelling, skin discoloration from internal bleeds, and bony prominences.

Achilles disorders or injuries can be identified by feeling for tenderness, gapping, irregularity, and fullness as well as checking to see if the patient still has a full range of motion at the ankle.

Researchers further identified that surgical approaches for the injuries should always be the last resort and only considered for acute tears in young or very active patients. According to their findings, patients with acute tears who remained active actually had a lesser chance of re-rupturing the tendon. However, for the majority of mildly active middle age to elderly patients, more conservative treatments were encouraged.

Daniels further stated in the study’s analysis that mismanaged or neglected Achilles injuries are certain to hinder patients and decrease the individual’s quality of life. Mismanaged Achilles tears may continue to grow which will result in the weakening of the leg. Typically, abnormal growths called nodules may form in the tendon making repairs more difficult and may also cause patients to develop chronic pain.

The researchers ask that practicing orthopedic doctors be aware of the risk factors prone to cause tendon disorders such as autoimmune disease, plantar fasciitis, obesity, and tobacco use and incorporate thorough medical history reviews and physical examinations prior to diagnosis or treatment methods.