Diagnostic domains, differential diagnosis and conditions requiring further medical attention that are considered important in the assessment for Achilles tendinopathy: a Delphi consensus study

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.

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Publication Details

Journal
British Journal of Sports Medicine
Published
2025-04-16
DOI
https://doi.org/10.1136/bjsports-2024-109185
Citations
9
Primary Topic
Tendon Structure and Treatment
Type
article
Field-Weighted Citation Impact
15.49
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article

Diagnostic domains, differential diagnosis and conditions requiring further medical attention that are considered important in the assessment for Achilles tendinopathy: a Delphi consensus study

Anne‐Sofie Agergaard, Amanda Lau, Lorenzo Masci, Samuel Ka-Kin Ling et al.
9 citations
British Journal of Sports Medicine
Tendon Structure and Treatment
15.49
article

Diagnostic domains, differential diagnosis and conditions requiring further medical attention that are considered important in the assessment for Achilles tendinopathy: a Delphi consensus study

Anne‐Sofie Agergaard, Amanda Lau, Lorenzo Masci, Samuel Ka-Kin Ling, Roald Bahr, Natália Franco Netto Bittencourt, Robert‐Jan de Vos, Nat Padhiar, Emma Cowley, Igor Sancho, Theodora Papadopoulou, Seth O’Neill, Jennifer A. Zellers, Suzy Speirs, Larissa Trease, Alex Scott, Marcelo Bordalo Rodrigues, Peter Malliaras, Nicola Maffulli, Annelie Brorsson, Per Hölmich, Ruth L. Chimenti, Ebonie Rio, Tanusha Cardoso, Vasileios Korakakis, Evi Wezenbeek, Jan A.N. Verhaar, Pieter P. R. N. d’Hooghe, Bill Vicenzino, Myles Murphy, Susan W. White, Sue Mayes, Karin Grävare Silbernagel, Siu Ngor Fu, Carol McCrum, Jonathan T. Finnoff, S. Child, Richard Newsham‐West, Kristian Thorborg, Diego Ruffino, Shawn L. Hanlon, Seán Mc Auliffe, Kornelia Kulig, Bruce Hamilton, Jaryd Bourke, Victoria Tzortziou Brown, Alicia M. James, Dylan Morrissey, Wayne Derman, Jonathan D Rees, Shiping Zhang, Yang Sun, Shannon E Munteanu, Jill Halstead, Jonathan Houghton, Katarina Maria Nilsson-Helander
article en
9 citations

Abstract

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.

British Journal of Sports MedicineVol. 59(13)
Universidade Federal de Minas Gerais (BR), University of Southern California (US), Edith Cowan University (AU), University of Iowa (US), Fundação de Amparo à Pesquisa do Estado da Bahia (BR), Universidad de Deusto (ES), University of British Columbia (CA), Hong Kong Polytechnic University (HK), California State University, Fullerton (US), English Institute of Sport (GB), University of Antwerp (BE), University of Leicester (GB), The University of Queensland (AU), Queen Mary University of London (GB), Universidad Nacional de Córdoba (AR), University of Nicosia (CY), Chinese University of Hong Kong (HK), Shanghai University of Sport (CN), La Trobe University (AU), Washington University in St. Louis (US), Barts Health NHS Trust (GB), University of Limerick (IE), Fudan University (CN), Sahlgrenska University Hospital (SE), Frederiksberg Hospital (DK), Leeds Community Healthcare NHS Trust (GB), Hvidovre Hospital (DK), Erasmus MC (NL), Sports Medicine Australia (AU), Copenhagen University Hospital (DK), Auckland University of Technology (NZ), United States Olympic & Paralympic Committee (US), Fudan University Shanghai Cancer Center (CN), Medical Defence Union (GB), Qatar Orthopaedic and Sports Medicine Hospital (QA), Oslo Sports Trauma Research Center (NO), NIHR Leeds Musculoskeletal Biomedical Research Unit (GB), Province of Antwerp (BE), Peninsula Health (AU), Monash Health (AU), Olympic Park Sports Medicine Centre (AU), Sports Science Institute of South Africa (ZA), Fortius Clinic (GB), Huashan Hospital (CN), Act Health (AU), University of Southampton (GB), Monash University (AU), Norwegian School of Sport Sciences (NO), Sapienza University of Rome (IT), University of Delaware (US), University of Gothenburg (SE), Erasmus University Rotterdam (NL), University of Colorado Denver (US), The University of Notre Dame Australia (AU), Birkbeck, University of London (GB)
Good health and well-being
Openalex Percentile: Top 1%
Tendon Structure and Treatment
15.49
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