TY - JOUR
T1 - Diagnostic domains, differential diagnosis and conditions requiring further medical attention that are considered important in the assessment for Achilles tendinopathy
T2 - a Delphi consensus study
AU - Peter Malliaras
AU - Malliaras, Peter
AU - Gravare Silbernagel, Karin
AU - de Vos, Robert-Jan
AU - Bourke, Jaryd
AU - Sancho, Igor
AU - Hanlon, Shawn L
AU - Agergaard, Anne-Sofie
AU - Bahr, Roald
AU - Bittencourt, Natália Franco Netto
AU - Bordalo, Marcelo
AU - Brorsson, Annelie
AU - Tzortziou Brown, Victoria
AU - Cardoso, Tanusha
AU - Child, Sally
AU - Chimenti, Ruth L
AU - Cowley, Emma
AU - D'Hooghe, Pieter
AU - Derman, Wayne
AU - Finnoff, Jonathan T
AU - Fu, Siu Ngor
AU - Halstead, Jill
AU - Hamilton, Bruce
AU - Nilsson-Helander, Katarina Maria
AU - Hölmich, Per
AU - Houghton, Jonathan
AU - James, Alicia M
AU - Kulig, Kornelia
AU - Lau, Amanda
AU - Ling, Samuel
AU - Maffulli, Nicola
AU - Masci, Lorenzo
AU - Mayes, Sue
AU - Mc Auliffe, Sean
AU - McCrum, Carol
AU - Morrissey, Dylan
AU - Munteanu, Shannon E
AU - Murphy, Myles Calder
AU - Newsham-West, Richard
AU - O'Neill, Seth
AU - Padhiar, Nat
AU - Papadopoulou, Theodora
AU - Rees, Jonathan D
AU - Rio, Ebonie Kendra
AU - Ruffino, Diego
AU - Scott, Alex
AU - Speirs, Suzy
AU - Sun, Yang
AU - Thorborg, Kristian
AU - Trease, Larissa
AU - Verhaar, Jan A N
N1 - © Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.
PY - 2025/7/1
Y1 - 2025/7/1
N2 - The absence of agreed methods to diagnose Achilles tendinopathy impedes research and clinical practice. This gap results in heterogeneous and/or poorly described study samples, making it challenging to apply findings in clinical practice. The aim of this Delphi study was to define consensus on (1) diagnostic domains; (2) differential diagnoses; and (3) conditions requiring further medical attention, when assessing for Achilles tendinopathy. We conducted a sequential three-stage process which included: (1) identifying diagnostic domains, differential diagnoses and conditions requiring further medical attention based on existing scoping reviews and clinical practice guidelines; (2) developing Delphi survey questions; and (3) administering a five-round Delphi online survey. Consensus was defined as ≥70% agreement. 52 participants completed the surveys. Four diagnostic domains were deemed essential and reached consensus (pain location (93%); pain during activity (97%); tests that provoke pain (87%); palpation to assess pain (83%)). 15 differential diagnoses reached consensus: 2 for both midportion and insertional (partial tear (80%); posterior ankle impingement (78%)), 6 for midportion (plantaris tendinopathy (84%); tibialis posterior or flexor hallucis longus tendinopathy/tenosynovitis (72%); flexor digitorum longus tendinopathy (77%); accessory soleus muscle (74%); paratendinopathy (86%); sural nerve neuropathy (81%)) and 7 for insertional (superficial (88%) and retrocalcaneal bursitis (86%); Haglund's/calcaneal exostosis (80%), intratendinous calcifications (73%); Sever's disease (78%); calcaneal stress reaction/fracture (80%); subtalar/ankle pain (71%)). Six conditions requiring further medical attention reached consensus: (Achilles tendon rupture (83%); systemic inflammatory joint disease (86%); metabolic syndrome (75%); familial hypercholesterolaemia (77%); endocrine and hormonal disorders (80%); drug reactions (77%)). This consensus identified essential diagnostic domains, differential diagnoses and conditions requiring further medical attention that should be considered when assessing for Achilles tendinopathy.
AB - The absence of agreed methods to diagnose Achilles tendinopathy impedes research and clinical practice. This gap results in heterogeneous and/or poorly described study samples, making it challenging to apply findings in clinical practice. The aim of this Delphi study was to define consensus on (1) diagnostic domains; (2) differential diagnoses; and (3) conditions requiring further medical attention, when assessing for Achilles tendinopathy. We conducted a sequential three-stage process which included: (1) identifying diagnostic domains, differential diagnoses and conditions requiring further medical attention based on existing scoping reviews and clinical practice guidelines; (2) developing Delphi survey questions; and (3) administering a five-round Delphi online survey. Consensus was defined as ≥70% agreement. 52 participants completed the surveys. Four diagnostic domains were deemed essential and reached consensus (pain location (93%); pain during activity (97%); tests that provoke pain (87%); palpation to assess pain (83%)). 15 differential diagnoses reached consensus: 2 for both midportion and insertional (partial tear (80%); posterior ankle impingement (78%)), 6 for midportion (plantaris tendinopathy (84%); tibialis posterior or flexor hallucis longus tendinopathy/tenosynovitis (72%); flexor digitorum longus tendinopathy (77%); accessory soleus muscle (74%); paratendinopathy (86%); sural nerve neuropathy (81%)) and 7 for insertional (superficial (88%) and retrocalcaneal bursitis (86%); Haglund's/calcaneal exostosis (80%), intratendinous calcifications (73%); Sever's disease (78%); calcaneal stress reaction/fracture (80%); subtalar/ankle pain (71%)). Six conditions requiring further medical attention reached consensus: (Achilles tendon rupture (83%); systemic inflammatory joint disease (86%); metabolic syndrome (75%); familial hypercholesterolaemia (77%); endocrine and hormonal disorders (80%); drug reactions (77%)). This consensus identified essential diagnostic domains, differential diagnoses and conditions requiring further medical attention that should be considered when assessing for Achilles tendinopathy.
U2 - 10.1136/bjsports-2024-109185
DO - 10.1136/bjsports-2024-109185
M3 - Article
C2 - 40240126
SN - 0306-3674
VL - 59
SP - 891
EP - 901
JO - British Journal of Sports Medicine
JF - British Journal of Sports Medicine
IS - 13
M1 - 9185
ER -