Course Case Study - Tendinopathy 2

 History of Present condition

Betty is a 38 year old female has been having a mild dull ache at the back of her left ankle for the past 12 months that over the past 2 months has become unbearable when she is training. She has been to see her doctor who has given her some NSAIDs but she didn’t take them as she doesn’t like taking medication.

Presenting Condition

Dull constant ache at the back of her left ankle with intermittent sharp pain.

Aggravating factors – running uphill and trying to increase her speed. Walking after being sat for more than 30 minutes, touching the back of her ankle.

Easing factors – Rest

24 hour pattern –

  • Morning - walking is very uncomfortable 7/10 VAS which eases to a dull ache 4/10 after an hour
  • Daytime – Pain is at best 2/10 dull ache and rises to 5/10 towards the end of the day whilst at work
  • Evening – Dull ache remains dependant on activity

Social History

Part time administrative assistant at an insurance firm works 25 hours a week. The majority of the work involves data inputting and customer phone calls.

She is married with no children. She has a dog which she takes out for 2 hours a day on long walks.

Her hobbies include going to a high intensity interval plyometric training class at the gym and she enters 10km races regularly every year. Although she has signed up to run a half marathon in 2 months.

Drug History

None

Objective Summary 

Observation - local swelling to left distal portion of the achilles tendon 
Alignment - nothing of note on the position of the heel and foot. Neutral posture.

Active ROM Passive ROM Ressisted ROM
Knee Full no pain Full no pain Full no pain
Ankle Dorsiflex Plantargrade discomfort +10degrees Pain 5/5 Oxford Scale no pain
Ankle Plantarflex -4/4 discomfort Full no pain 4/5  pain +
Ankle Eversion Full no pain Full no pain Full no pain
Ankle Inversion Full no pain Full no pain Full no pain


Palpation - Tender over insertion and distal portion of achilles tendon.

Functional assessment:

  • Heel raises bilaterally - wasting obvious on left calf
  • Single left heel raise - weakness and unable to achieve full range with discomfort
  • Double leg squat - nothing obvious of note 
  • Sinlge right leg squat - pelvic inferior tilt on left
  • Sinlge left leg squat - decrease range through squat and valgus shift at knee
  • Walking - no over pronation / supination good aligement