Differential Diagnosis for Achilles Tendon Pain
The differential diagnosis for Achilles tendon pain can be categorized into the following groups:
- Single Most Likely Diagnosis
- Achilles Tendinopathy: This is the most common cause of Achilles tendon pain, characterized by inflammation and degeneration of the tendon. It is often related to overuse or repetitive strain, especially in athletes.
- Other Likely Diagnoses
- Achilles Tendon Rupture: A partial or complete tear of the Achilles tendon, which can occur suddenly due to trauma or overuse. It is more common in older athletes or those with pre-existing tendinopathy.
- Insertional Achilles Tendinopathy: Inflammation and degeneration of the tendon at its insertion point on the calcaneus, often caused by repetitive strain or poor foot mechanics.
- Haglund's Deformity: A bony prominence on the posterior aspect of the calcaneus that can cause friction and inflammation on the Achilles tendon.
- Do Not Miss Diagnoses
- Infection (e.g., Cellulitis or Abscess): Although rare, infection in the vicinity of the Achilles tendon can have serious consequences if not promptly treated.
- Tumor (e.g., Soft Tissue Sarcoma): Although extremely rare, a tumor affecting the Achilles tendon or surrounding tissues is a critical diagnosis not to miss.
- Rheumatologic Conditions (e.g., Rheumatoid Arthritis, Ankylosing Spondylitis): These conditions can cause Achilles tendon pain and are important to consider, especially if there are systemic symptoms or other joint involvement.
- Rare Diagnoses
- Achilles Tendon Xanthoma: A rare condition characterized by the accumulation of lipid-laden macrophages within the tendon, often associated with hyperlipidemia.
- Achilles Tendon Lipoma: A rare benign tumor composed of fat cells that can cause pain and swelling in the Achilles tendon region.
- Seronegative Spondyloarthropathy: A group of conditions (e.g., psoriatic arthritis, reactive arthritis) that can cause Achilles tendon pain and are important to consider, especially if there are other systemic symptoms or skin manifestations.