Put your clinical reasoning
to the test.

Clue 1

A 42-year-old recreational runner reports a gradual onset of posterior ankle pain after adding hill sessions to their weekly training.

Clue 2

Symptoms are stiff on the first few steps in the morning, ease after warming up, and are often more noticeable the day after running.

Clue 3

Palpation reproduces familiar pain and reveals local thickening 2–6 cm above the calcaneal insertion.

Clue 4

A single-leg calf raise and repeated hopping reproduce symptoms. There is no pain at the tendon insertion and the Thompson test is negative.

Clue 5

Tenderness reduces when the tendon is placed under tension in dorsiflexion, and the painful thickened area moves with the tendon during active ankle movement.