What is the best clinical test for Achilles tendinopathy?
Achilles tendinopathies (AT) can be ambiguous to diagnose, with multiple differential diagnoses such as complete/partial rupture, bursitis, bone/cartilage pathologies, anomalous soleus, plantar fasciitis, tarsal tunnel syndrome, etc. The aim of this study was to identify and evaluate clinical tests used to diagnose chronic mid-portion AT.
21 participants were recruited; 10 patients with chronic mid-portion AT (Group A), 6 patients with posterior ankle pain (but not AT) (Group B), and 5 control asymptomatic subjects (Group C). All diagnoses were confirmed by ultrasound scanning (gold standard), subjects were assessed in a randomised order by clinicians blinded to their diagnosis. The results showed:
- The literature review identified 10 tests: Reported pain location, Morning stiffness, Painful palpation, Tendon Thickening, Crepitus, Royal London Test, Arc sign, Painful passive dorsiflexion, Painful resisted plantarflexion (heel raise), Painful plyometric loading (hopping);
- The most sensitive (>78%) tests were Morning stiffness, Painful palpation and Reported pain location;
- The most specific (>76%) tests were Arc sign, Crepitus, Single-leg heel raise, Royal London Test, Tendon thickening, Hop test, Passive dorsiflexion and Reported pain location;
- The most reliable tests (K=0.75) were Reported pain location, Painful palpation, Arc sign, Morning stiffness.
In conclusion, the authors identified only "Reported pain location" and "Painful palpation" as tests that are sufficiently sensitive, specific and reliable to be recommended in clinical use. > From: Hutchinson et al., J Foot Ankle Surg 19 (2013) 112–117. All rights reserved to Elsevier Ltd.
The Pubmed summary of the article can be found here.
Extensive information about the anatomy and biomechanics of the achilles tendon can be viewed in the videopresentations below: