The clinical diagnosis of Achilles tendinopathy: a scoping review

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

Changes in Achilles Tendon Thickness Following a 10-Week Heavy Load Eccentric Exercise Program

Achilles tendinopathy often presents with increased tendon thickness, lower echogenicity, and decreased stiffness. Interestingly, tendons are also able to adapt their structural and mechanical characteristics in response to loading. Eccentric exercise for Achilles tendinopathy continues to be the recommended treatment. The majority of individuals with midportion achilles tendinopathy have shown favorable response to eccentric exercise

Achilles tendinopathy and eccentric exercise, a narrative review

[Resumen] Objetivos: El objetivo principal de esta revisión bibliográfica es conocer la aplicación más eficaz según la ciencia de ejercicio excéntrico (EE) a la hora de manejar la TA. Los objetivos secundarios son conocer las diferencias entre sexos al recibir el tratamiento de ejercicio excéntrico en la TA y conocer el mecanismo de acción del EE en la TA. Material y Métodos: Se realizó una búsqueda bibliográfica en la base de datos PubMed. Se usaron los siguientes términos: “Tendinopathy”, “Tendinopathy treatment”, “Tendinopathy eccentric” “Tendinopathy eccentric exercise”, “Achilles tendinopathy”, “Achilles tendinopathy treatment”, “Achilles tendinopathy rehabilitation”, “Achilles tendinopathy physical therapy”, “Achilles tendinopathy exersice”, “Achilles tendinopathy eccentric”. Se seleccionaron artículos que aportaban calidad metodológica, relevancia científica, o una visión novedosa. Resultados: Se encontraron artículos que apoyan la aplicación de EE como tratamiento de la TA y la dosificación recomendada. Se encontraron varios artículos que teorizan sobre los efectos del EE en la TA. Se encontró un artículo que diferencia los efectos del EE en hombres y en mujeres en la TA. Conclusiones: El EE sería el tratamiento de elección en una TA. El protocolo de Alfedson cuenta con la mayoría de los apoyos científicos. En el futuro será necesario realizar estudios de mayor calidad metodológica sobre diferentes opciones de ejercicio. No quedan claros cuáles son los mecanismos de acción del EE en la TA. Queda demostrado que los efectos del EE en las mujeres son limitados en comparación con los hombres.[Abstract] Objectives: The main objective of this bibliographical review is to know the most effective application according to the science of eccentric exercise (EE) when it comes to managing Aquilles Tendinopathy (AT). The secondary objectives are to know the differences between the sexes when receiving the treatment of eccentric exercise in the AT and to know the mechanism of action of EE in the AT. Methods: A literature search was made in the PubMed database. The following terms were used: “Tendinopathy”, “Tendinopathy treatment”, “Tendinopathy eccentric” “Tendinopathy eccentric exercise”, “Achilles tendinopathy”, “Achilles tendinopathy treatment”, “Achilles tendinopathy rehabilitation”, “Achilles tendinopathy physical therapy”, “Achilles tendinopathy exersice”, “Achilles tendinopathy eccentric”. We selected articles that provided methodological quality, scientific relevance, or a novel vision. Results:We found articles that support the application of EE as a treatment for AT and the recommended dosage. We found several articles that theorize about the effects of EE on AT. An article was found that differentiates the effects of EE in men and women in AT. Conclusions: EE is the treatment of choice in AT. The Alfedson protocol has the most scientific support. In the future it will be necessary to carry out studies of higher methodological quality on different exercise options. It is not clear what are the mechanisms of EE action in the TA. It is shown that the effects of EE in women are limited compared to me

Incidence of midportion Achilles tendinopathy in the general population

Background Achilles tendon disorders, like Achilles tendinopathy, are very common among athletes. In the general population, however, knowledge about the incidence of Achilles tendinopathy is lacking. Desi

Variants within the COMP and THBS2 genes are not associated with Achilles tendinopathy in a case-control study of South African and Australian populations

Cartilage oligomeric matrix protein is a structural protein of the extracellular matrix, while thrombospondin-2 is a matricellular protein involved in cell–matrix interactions. Recent studies have shown that genetic variation is a significant risk factor for Achilles tendinopathy, and the genes encoding cartilage oligomeric matrix protein (COMP) and thrombospondin-2 (THBS2) were identified as good candidate genes for association with Achilles tendinopathy. This study aimed to test the association of sequence variants within these candidate genes with the risk of Achilles tendinopathy in participants from South Africa (SA) and Australia (AUS). Three-hundred and forty (133 SA; 207 AUS) control participants with no history of Achilles tendinopathy and 178 (94 SA; 84 AUS) participants clinically diagnosed with Achilles tendinopathy were genotyped for five single nucleotide polymorphisms within the COMP and THBS2 genes in this case-control study. There was no difference in genotype distributions between control and tendinopathy groups for either the THBS2 variants rs9505888, rs6422747 and rs9283850, or the COMP variants rs730079 and rs28494505 in the SA and AUS populations. As the selection of COMP and THBS2 as candidate genes was hypothesis driven, based on biological function, the possibility that other variants within these genes are associated with Achilles tendinopathy cannot be excluded.Web of Scienc

Plantaris excision reduces pain in Mid-portion Achilles tendinopathy even in the absence of plantaris tendinosis

Background It is becoming increasingly apparent that the plantaris can contribute to symptoms in at least a subset of patients with mid-portion Achilles tendinopathy. However the nature of its involvement remains unclear. Hypothesis / Purpose To determine whether excised plantaris tendons from patients with mid-portion Achilles tendinopathy display tendinopathic changes and whether the presence of such changes affect clinical outcomes. Methods Sixteen plantaris tendons patients with mid-portion Achilles tendinopathy recalcitrant to conservative management underwent histological examination for the presence of tendinopathic changes. All patients had imaging to confirm the presence of the plantaris tendon adherent to or invaginated into the focal area of Achilles tendinosis. Visual analogue scores (VAS) and foot and ankle outcome scores (FAOS) were recorded pre and post-operatively. Results Sixteen patients (mean age 26.2; 18-47 years) underwent surgery with a mean follow-up of 14 months (range 6-20 months). The plantaris tendon was histologically normal in 13/16 cases (81%). Inflammatory changes in the loose peritendinous connective tissue surrounding the plantaris tendon were evident in all cases. There was significant improvement in mean VAS scores (p<0.05) and all domains of the FAOS post-operatively (p<0.05). Conclusions The absence of any tendinopathic changes in the excised plantaris of 13 patients who clinically improved suggests plantaris involvement with Achilles tendinopathy may not yet be fully understood and supports the concept that this may be a compressive or a frictional phenomenon rather than purely tendinopathic. Clinical Relevance There is increasing evidence to support that the excision of plantaris results in improved clinical outcomes in a sub-set of patients with mid-portion Achilles tendinopathy. Prior findings have reported that excised plantaris tendons from these patients display tendinopathic changes. However these findings suggest the role of plantaris in the pathology of these patients could be biomechanical since patients improved even when the excised plantaris was not tendinopathic

Variants within the MMP3 gene are associated with achilles tendinopathy: possible interaction with the COL5A1 gene

Objectives: Sequence variation within the COL5A1 and TNC genes are known to associate with Achilles tendinopathy. The primary aim of this case-control genetic association study was to investigate whether variants within the matrix metalloproteinase 3 (MMP3) gene also contributed to both Achilles tendinopathy and Achilles tendon rupture in a Caucasian population. A secondary aim was to establish whether variants within the MMP3 gene interacted with the COL5A1 rs12722 variant to raise risk of these pathologies. Methods: 114 subjects with symptoms of Achilles tendon pathology and 98 healthy controls were genotyped for MMP3 variants rs679620, rs591058 and rs650108. Results: As single markers, significant associations were found between the GG genotype of rs679620 (OR = 2.5, 95% CI 1.2 to 4.90, p = 0.010), the CC genotype of rs591058 (OR = 2.3, 95% CI 1.1 to 4.50, p = 0.023) and the AA genotype of rs650108 (OR = 4.9, 95% CI 1.0 to 24.1, p = 0.043) and risk of Achilles tendinopathy. The ATG haplotype (rs679620, rs591058, and rs650108) was under-represented in the tendinopathy group when compared to the control group (41% vs 53%, p = 0.038). Finally, the G allele of rs679620 and the T allele of COL5A1 rs12722 significantly interacted to raise risk of AT (p = 0.006). No associations were found between any of the MMP3 markers and Achilles tendon rupture. Conclusion: Variants within the MMP3 gene are associated with Achilles tendinopathy. Furthermore, the MMP3 gene variant rs679620 and the COL5A1 marker rs12722 interact to modify the risk of tendinopathy. These data further support a genetic contribution to a common sports related injur

Factors Related to Intra-Tendinous Morphology of Achilles Tendon in Runners

The purpose of this study was to determine and explore factors (age, sex, anthropometry, running and injury/pain history, tendon gross morphology, neovascularization, ankle range of motion, and ankle plantarflexor muscle endurance) related to intra-tendinous morphological alterations of the Achilles tendon in runners. An intra-tendinous morphological change was defined as collagen fiber disorganization detected by a low peak spatial frequency radius (PSFR) obtained from spatial frequency analysis (SFA) techniques in sonography. Ninety-one runners (53 males and 38 females; 37.9 ± 11.6 years) with 8.8 ± 7.3 years of running experience participated. Height, weight, and waist and hip circumferences were recorded. Participants completed a survey about running and injury/pain history and the Victorian Institute of Sport Assessment-Achilles (VISA-A) survey. Heel raise endurance and knee-to-wall composite dorsiflexion were assessed. Brightness-mode (B-mode) sonographic images were captured longitudinally and transversely on the Achilles tendon bilaterally. Sonographic images were analyzed for gross morphology (i.e., cross-sectional area [CSA]), neovascularization, and intra-tendinous morphology (i.e., PSFR) for each participant. The factors associated with altered intra-tendinous morphology of the Achilles tendon were analyzed using a generalized linear mixed model. Multivariate analyses revealed that male sex was significantly associated with a decreased PSFR. Additionally, male sex and the presence of current Achilles tendon pain were found to be significantly related to decreased PSFR using a univariate analysis. Our findings suggested that male sex and presence of current Achilles tendon pain were related to intra-tendinous morphological alterations in the Achilles tendon of runners

Physiotherapy Management for Cases of Achilles Tendinopathy in Indonesian Para Athletics Athletes : Case Report

Achilles tendinopathy is a degenerative process due to excessive and cumulative use of microtrauma with internal and external risk factor. Approximately 52% of runners experience an Achilles tendinopathy (AT) injury during their lifetime. Achilles Tendinopathy can limit Indonesia's athletic performance due to pain on the side of the knee during running, walking and jumping. The aim of this study was to evaluate the physiotherapy management for Achilles Tendinopathy cases in Indonesian para-athletics. This research is a descriptive case studyinvolving one client with participatory observation. The physiotherapy intervention involved modality intervention using Eccentric exercises, ESWT, Stretching, Muscle release, Electrical Stimulation, and Cryotheraphy. The subject of the study was An. B, a 28 year old para athlete with height 182 cm, weight 77 kg, and BMI 23.3 in the ideal category. The patient came to the physiotherapy clinic of NPC Indonesia on 20 August 2023 with complaints of pain and burning in the left leg. Physical examination showed normal results except for pain examination using Numeric Rating Scale (NRS), where silent pain 0/10, tenderness 9/10, and motion pain 7/10 were found. The diagnosis of Achilles Tendinopathy sinistra was confirmed through specific examination. After four physiotherapy sessions Based on the results of studies that have been carried out, ESWT and Eccentric exercise can reduce pain, increase joint range of motion, increase muscle strength, increase ankle stability and improve functional abilities in Achilles tendinopathy patients