American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the characteristic symptom of Achilles tendinopathy?

1. Burning heel pain that improves with activity

2. Sharp pain in the medial ankle

3. Stiffness that worsens with rest

4. Burning heel pain and stiffness that worsen with activity

The correct answer is: Burning heel pain and stiffness that worsen with activity

The characteristic symptom of Achilles tendinopathy includes progressive burning heel pain and stiffness that typically worsen with activity. This condition often presents as localized pain along the Achilles tendon, particularly during activities that involve running or jumping. Patients may initially experience mild discomfort that becomes more pronounced with physical exertion. As the condition progresses, the stiffness that occurs in the tendon can also lead to increased pain after activity, particularly in the morning or after prolonged periods of rest. In contrast, Achilles tendinopathy is less commonly associated with sharp pain in the medial ankle, nor is it typically characterized by improvement of symptoms with activity. The hallmark of the condition is actually the pain that intensifies with repetitive use and activity rather than a classic “burning” sensation evenly distributed through the heel and tendon. Moreover, while stiffness can be part of the presentation, it is more accurately reflected as a component that worsens with activity rather than simply after rest, highlighting the specific nature of the condition's symptomatic profile.