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Background Achilles tendinopathy (AT) occurs in half of the elite runners. AT is a difficult‐to‐treat tendon disease, which may progress from new onset to a chronic state. It is unknown how many runners with new‐onset AT develop persisting symptoms and which prognostic factors are associated with this course. Objective To describe how many runners develop persisting symptoms 1 year after onset of reactive AT. Study Design Prospective cohort study. Methods Runners registering for a Dutch running event (5‐42.2 km) were eligible for inclusion. Runners reporting new‐onset AT between registration for the running event and 1 month after received a 1‐year follow‐up questionnaire. The 1‐year follow‐up questionnaire inquired about persisting symptoms (yes/no), running activity, and metabolic disorders. We calculated the percentage of runners with persisting symptoms and performed a multivariable logistic regression analysis to study the association between potential prognostic factors and persisting symptoms. Results Of 1929 participants, 100 runners (5%) reported new‐onset AT. A total of 62 runners (62%) filled in the 1‐year follow‐up questionnaire. Persisting symptoms were reported by 20 runners (32%). A higher running distance per week before new‐onset AT was associated with a lower risk of developing persisting symptoms (odds ratio (OR): 0.9, 95% confidence interval (CI): [0.9;1.0]). There was a positive trend toward an association between metabolic disorders and persisting symptoms (OR: 5.7, 95% CI: [0.9;36.2]). Conclusion One third of runners develop persisting symptoms 1 year after new‐onset AT. Interestingly, a higher running distance per week before new‐onset AT potentially lowers the risk of developing persisting symptoms.

Objectives: To analyse whether (1) passive or active pain coping strategies and (2) presence of neuropathic pain component influences the change of Achilles tendinopathy (AT) symptoms over a course of 24 weeks in conservatively-treated patients. Design: Prospective cohort study. Methods: Patients with clinically-diagnosed chronic midportion AT were conservatively treated. At baseline, the Pain Coping Inventory (PCI) was used to determine scores of coping, which consisted of two domains, active and passive (score ranging from 0 to 1; the higher, the more active or passive). Presence of neuropathic pain (PainDETECT questionnaire, −1 to 38 points) was categorized as (a) unlikely (≤12 points), (b) unclear (13-18 points) and (c) likely (≥19 points). The symptom severity was determined with the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire (0-100) at baseline, 6, 12 and 24 weeks. We analysed the correlation between (1) PCI and (2) PainDETECT baseline scores with change in VISA-A score using an adjusted Generalized Estimating Equations model. Results: Of 80 included patients, 76 (95%) completed the 24-weeks follow-up. The mean VISA-A score (standard deviation) increased from 43 (16) points at baseline to 63 (23) points at 24 weeks. Patients had a mean (standard deviation) active coping score of 0.53 (0.13) and a passive score of 0.43 (0.10). Twelve patients (15%) had a likely neuropathic pain component. Active and passive coping mechanisms and presence of neuropathic pain did not influence the change in AT symptoms (p = 0.459, p = 0.478 and p = 0.420, respectively). Conclusions: Contrary to widespread belief, coping strategy and presence of neuropathic pain are not associated with a worse clinical outcome in this homogeneous group of patients with clinically diagnosed AT.

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