Two Clinical Tests Commonly Used to Identify Achilles Tendinopathy

Pain in the back of the heel or lower calf is often associated with Achilles tendinopathy, a condition involving irritation and reduced load tolerance of the Achilles tendon. While imaging can sometimes be used, a diagnosis is often made through a clinical examination that includes a detailed history and specific physical tests.

Research has examined which clinical tests are most helpful in identifying Achilles tendinopathy. Two simple tests frequently used in physical therapy evaluations are the painful arc test and the Royal London Hospital test. Understanding these tests can help patients better appreciate how clinicians determine whether the Achilles tendon is the source of their symptoms.

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Why Clinical Tests Matter

Achilles tendinopathy shares symptoms with several other conditions that can cause pain in the back of the ankle, including:

• Retrocalcaneal bursitis

• Paratenon irritation

• Partial tendon tears

• Calf muscle strain

Because of this overlap, clinicians rely on targeted physical examination tests to help differentiate tendon-related pain from other potential sources.

The painful arc test and the Royal London Hospital test are two commonly used assessments because they help identify localized tendon involvement.

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The Painful Arc Test

The painful arc test evaluates whether pain is associated with a specific portion of the Achilles tendon.

During the test, the clinician palpates the tendon while the ankle moves between a relaxed and stretched position.

What the Clinician Is Looking For

In individuals with Achilles tendinopathy, the area of tenderness typically corresponds to a thickened segment of the tendon.

When the ankle moves, this painful section may appear to shift position along with the tendon. This movement indicates that the painful structure is part of the tendon itself rather than a surrounding tissue.

Why This Matters

If the painful region moves as the ankle moves, it suggests that the tendon tissue is involved. In contrast, pain originating from nearby structures—such as a bursa—would remain in the same location regardless of tendon movement.

This test helps clinicians determine whether the Achilles tendon itself is likely the source of the symptoms.

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The Royal London Hospital Test

The Royal London Hospital test focuses on how tendon tension affects pain sensitivity.

How the Test Works

First, the clinician identifies the most painful spot along the Achilles tendon with the ankle in a relaxed position. The ankle is then placed in a dorsiflexed position (where the foot is gently pulled upward), which tightens the tendon.

The clinician then presses on the same spot again.

What a Positive Test Looks Like

In individuals with Achilles tendinopathy, tenderness often decreases when the tendon is placed under tension.

This occurs because tightening the tendon compresses the affected tissue, temporarily reducing the ability to provoke pain with palpation.

What This Suggests

A reduction in pain with the tendon under tension is considered consistent with Achilles tendinopathy and helps distinguish it from other causes of posterior ankle pain.

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Clinical Tests Are Only One Piece of the Puzzle

While these tests provide valuable information, they are always interpreted within the broader context of a comprehensive evaluation.

A thorough assessment typically also includes:

• Review of symptoms and activity history

• Observation of walking and running mechanics

• Evaluation of calf strength and endurance

• Assessment of ankle mobility

• Single-leg loading capacity

Together, these components help determine not only whether Achilles tendinopathy is present, but also what factors may be contributing to it.

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The Importance of an Accurate Diagnosis

Identifying Achilles tendinopathy accurately is important because it guides treatment decisions. Tendons typically respond best to progressive, well-structured loading programs that gradually restore their strength and capacity.

When the condition is properly identified and managed, most individuals can return to their normal activities with improved tendon resilience.

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Ready to Address Your Achilles Pain?

If you are experiencing persistent heel or tendon pain, a comprehensive evaluation can help determine whether Achilles tendinopathy is involved and what steps may support recovery.

Learn more about our Achilles Tendinopathy Program and book your evaluation to begin a personalized plan designed to restore strength, reduce pain, and help you return to the activities you enjoy.

Book your evaluation today!