Out of 10 clinical tests, 'Where does it hurt?' is the most common question. Such a question is one of the most reliable and accurate tests for diagnosing Achilles tendinopathy. It also happens to be a 'where' related question.
In the not too distant past, the Journal of Foot and Ankle Surgery published a scientific study entitled 'What is the best clinical test for Achilles tendinopathy?' The study by Hutchison and colleagues from the United Kingdom was published in 2013.
There is a long-standing rumour that published scientific knowledge requires 20 years to integrate into routine clinical practice. For this reason alone, this post seemed necessary as Achilles tendinopathy is a prevalent problem facing athletes and non-athletes.
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In 2011, de Jonge and colleagues (2011) estimated that 2 per 1,000 in the general population had what is known as mid-portion Achilles tendinopathy. This would equate to an annual incidence rate in Europe of approximately 4.5 million cases per year.
Pain location provides insight for Achilles tendinopathy
The authors assessed the accuracy and validity of ten clinical tests commonly employed by physiotherapists and general practitioners to reach a differential diagnosis of Achilles pathology. Hutchison and colleagues (2013) found subjective reports of pain and palpation were the most accurate and valid clinical tests. Further, any combination of the ten tests did not give a better prediction. Thus the authors recommend no other clinical tests.
Everything should be made as simple as possible, but not simpler – Albert Einstein.
A location element is present in about 90% of all pain complaints. In this case, patients report pain 2-6 cm above the Achilles tendon's insertion to the calcaneum. This means, to formulate a clinical diagnosis of mid-body Achilles tendinopathy, the self-report of pain can be used with a high positive predictive value. Therefore, it is highly likely that an ultrasound would only confirm the already achieved diagnosis.
Differential diagnosis can be facilitated by ultrasound and magnetic resonance imaging (MRI). So we can replace costly and time-consuming procedures with pain reports and palpation tests.
So then the next question is how much can Achilles tendinopathy pain differ between patients? We are looking forward to hearing what our Navigate Pain users find out.
References
Hutchison AM, Evans R, Bodger O, Pallister I, Topliss C, Williams P, Vannet N, Morris V, Beard D. What is the best clinical test for Achilles tendinopathy? Foot Ankle Surg. 2013 Jun;19(2):112-7.
de Jonge S, van den Berg C, de Vos RJ, et al. Incidence of midportion Achilles tendinopathy in the general population Br J Sports Med 2011;45:1026-1028.
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