Most patients complain of pain, usually worse after activities and easing as they begin to exercise. A few mainly complain of swelling in or around the tendon.
Patients with insertional tendonopathy may complain of difficulty with shoe fitting, especially if they have a Haglund's deformity.
Some people present with quite acute flare-ups of pain, swelling and limp, which are probably due to partial tears of the tendon.
There may be a clear relation to taking up a new sport, or changing training regimes, shoes, distances run or orthotics. There is some evidence that inadequate warm-up contributes to tendon pain, and this should be asked about.
All patients should be asked about:
- inflammatory joint disease, including extra-articular features, inflammatory bowel disease and psoriasis
- diabetes
- neurological disease
- circulatory problems
- family history of foot problems, arthritis or neurological disease
- trauma to the foot
- what treatment has been tried before, particularly orthotics