American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the most common diagnosis associated with posterior heel pain, stiffness, and tenderness proximal to the Achilles tendon insertion?

1. Achilles tendon rupture

2. Plantar fasciitis

3. Achilles tendinopathy

4. Tarsal tunnel syndrome

The correct answer is: Achilles tendinopathy

The most common diagnosis associated with posterior heel pain, stiffness, and tenderness proximal to the insertion of the Achilles tendon is Achilles tendinopathy. This condition involves overuse and degeneration of the Achilles tendon, often arising due to repetitive strain in activities such as running or jumping. Pain is typically felt just above the tendon insertion at the calcaneus and can be accompanied by stiffness, particularly in the morning or after periods of inactivity. In this scenario, individuals with Achilles tendinopathy often report tenderness upon palpation of the affected area and experience pain that worsens with activity. The anatomical location of the pain and the nature of the symptoms are characteristic of this condition. Other conditions, while they can cause heel pain, present with different mechanisms and symptoms. Achilles tendon rupture, for instance, usually presents with an acute onset of severe pain and a feeling of having been kicked in the back of the heel, rather than gradual stiffness and tenderness. Plantar fasciitis primarily manifests with pain at the bottom of the heel, particularly with the first steps in the morning, while tarsal tunnel syndrome is characterized by pain and numbness along the medial aspect of the foot and is not typically associated with proximal tenderness to the Achilles tendon.