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Achilles Pain

In some cases, patients presenting this is rare, we want to be certain we, as physical therapists, are able to help.

Some of the symptoms we look for include:

  • Fever, chills, night sweats (increased risk of infection or cancer)
  • Weight loss (concern of cancer or infection)
  • Recent infection (increased risk of infection)

Medication-specific concerns include:

  • Steroids (risk of osteoporosis)
  • Anti-coagulants (risk of bleeding)
  • Immunosuppressants (risk of infections)

The Ottawa Ankle Rules were created to determine if a patient needs X-rays following an acute ankle injury. A patient needs X-rays if there is:

  • Pain in the malleolar zone (see image below)
  • Any of the following:
    • Bone tenderness along the distal 6 cm of the back edge of the tibia or tip of the medial malleolus
    • The inability to bear weight both immediately and in the emergency department for four steps

Image credit http://www.ohri.ca/emerg/cdr/docs/cdr_ankle_poster.pdf


  1. Martin, Robroy L. et al. “Achilles Pain, Stiffness, And Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018.” Journal of Orthopaedic & Sports Physical Therapy, Vol. 48, No. 5, 2018, pp. A1-A38. Journal of Orthopaedic & Sports Physical Therapy (JOSPT), https://doi.org/10.2519/jospt.2018.0302.

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