Patients who mainly complain of pain during exercise generally have paratendonopathy
Patients who complain of pain after exercise generally have tendonopathy. ASk the patient to localise the pain they feel. Hutchison (2013) found that pain localised to the mid portion of the Achilles tendon was the most predictive subjective feature for a diagnosis of tendonopathy.
Patients with insertional tendonopathy may complain of difficulty with shoe fitting, especially if they have a Haglund's deformity.
Some patients have a mixed picture.
Some people present with quite acute flare-ups of pain. While many of these just represent acute exacerbations or small interstitial tears, they should be taken seriously as acute complete ruptures are sometimes missed only to present weeks or months later as "tendonitis".
There may be a clear relation to taking up a new sport, or changing training regimes, shoes, distances run or orthotics. There is some evidence that inadequate warm-up contributes to tendon pain, and this should be asked about.
All patients should be asked about:
- inflammatory joint disease, including extra-articular features, inflammatory bowel disease and psoriasis
- neurological disease
- circulatory problems
- family history of foot problems, arthritis or neurological disease
- trauma to the foot
- what treatment has been tried before, particularly orthotics