The clinical diagnosis of Achilles tendinopathy: a scoping review

Abstract

Background Achilles tendinopathy describes the clinical presentation of pain localised to the Achilles tendon and associated loss of function with tendon loading activities. However, clinicians display differing approaches to the diagnosis of Achilles tendinopathy due to inconsistency in the clinical terminology, an evolving understanding of the pathophysiology, and the lack of consensus on clinical tests which could be considered the gold standard for diagnosing Achilles tendinopathy. The primary aim of this scoping review is to provide a method for clinically diagnosing Achilles tendinopathy that aligns with the nine core health domains. Methodology A scoping review was conducted to synthesise available evidence on the clinical diagnosis and clinical outcome measures of Achilles tendinopathy. Extracted data included author, year of publication, participant characteristics, methods for diagnosing Achilles tendinopathy and outcome measures. Results A total of 159 articles were included in this scoping review. The most commonly used subjective measure was self-reported location of pain, while additional measures included pain with tendon loading activity, duration of symptoms and tendon stiffness. The most commonly identified objective clinical test for Achilles tendinopathy was tendon palpation (including pain on palpation, localised tendon thickening or localised swelling). Further objective tests used to assess Achilles tendinopathy included tendon pain during loading activities (single-leg heel raises and hopping) and the Royal London Hospital Test and the Painful Arc Sign. The VISA-A questionnaire as the most commonly used outcome measure to monitor Achilles tendinopathy. However, psychological factors (PES, TKS and PCS) and overall quality of life (SF-12, SF-36 and EQ-5D-5L) were less frequently measured. Conclusions There is significant variation in the methodology and outcome measures used to diagnose Achilles tendinopathy. A method for diagnosing Achilles tendinopathy is proposed, that includes both results from the scoping review and recent recommendations for reporting results in tendinopathy.

An Isometric and Functionally Based 4-Stage Progressive Loading Program in Achilles Tendinopathy: A 12-Month Pilot Study

“…Tenderness on palpation is an integral part of the clinical examination in the diagnosis of AT, despite only having modest documentation of the clinical value [ 6 , 60 ]. We wanted to assess whether tenderness on palpation changed over time in relation to both the VISA-A score and US outcomes.…”

Current and future advances in practice: mechanical foot pain

“…People with Achilles tendinopathy report pain and stiffness in the Achilles tendon region, with an insidious onset that is aggravated by loading activities, such as running and jumping [ 92 , 100 ]. During a physical assessment, patients can experience pain and display weakness with single-leg heel raise and hopping.…”

Prevalence and Risk Factors of Achilles Tendinopathy among University Soccer Players

“…The Royal London test, a psychometrically sound instrument, was used for assessing Achilles tendinopathy [18,19]. To start the test, the participant lay prone on the plinth with the feet hanging outside the table.…”