Your health professional will usually diagnose an Achilles tendon problem through a medical history and physical examination. During the physical exam, he or she will:

• Check for tenderness. Achilles tendinopathy usually makes the tendon tender to the touch.
• Check your lower leg for gaps in your Achilles tendon, thickening of the tendon, nodules on the tendon, or bony growths on the heel bone.
• Compare your legs to see what is normal motion and how the injury (tendinosis or rupture) has affected the lower leg and ankle. Your health professional will check for changes not only in strength but also in nerve and circulatory symptoms, such as lack of feeling in the area.

To help identify a tear or rupture, your health professional will:

• Squeeze your calves. How your feet move when your calves are squeezed can help diagnose a rupture. A partial tear of the Achilles tendon can be difficult to diagnose when there is minimal pain and near-normal strength after the initial tear. If there is a partial tear, the calf squeeze test may be normal, but a defect may be felt in the tendon.
• Observe how you stand and walk. A sign of a ruptured tendon is not being able to walk on your toes. You may or may not be able to stand and bear weight.

Further tests may be done to clarify a diagnosis or to prepare for surgery. These tests include:

• Magnetic resonance imaging (MRI), to evaluate Achilles tendinopathy. See an illustration of an MRI of the Achilles tendon.
• Ultrasound, to evaluate whether there is a rupture of the tendon, or signs of tendinopathy.
• X-rays, to evaluate the heel bone.