Clinical Diagnosis of Achilles Tendinopathy With Tendinosis

Maffulli, Nicola; Kenward, Michael G.; Testa, Vittorino; Capasso, Giovanni; Regine, R.; King, John B.

doi:10.1097/00042752-200301000-00003

Cited by 218 publications

(146 citation statements)

References 19 publications

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“…The diagnosis of Achilles tendinopathy is clinical, with pain, swelling, and impaired performance as the cardinal signs [22,28,30]. Symptomatic tendinopathic Achilles tendons with neovascularization show evidence of a statistically significant association between site of maximum tenderness on palpation and site of maximum presence of PDU neovessels [16].…”

Section: Diagnosismentioning

confidence: 99%

Neovascularization in Achilles tendinopathy: have we been chasing a red herring?

Tol

Spiezia

Maffulli

2012

Knee Surg Sports Traumatol Arthrosc

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The concept of neovascularization in tendinopathy seems to have gained nearly mythological proportions and quasi-religious state: it is considered of diagnostic and prognostic value, related to clinical outcome, and the exclusive target of some therapeutic interventions. However, we question whether these assumptions are based on scientific evidence, and we come to the conclusion that, in the light of recent well-performed research, it seems that detecting neovessels has no additional value for the diagnosis, no firmly confirmed prognostic value, and no proven relation with symptoms. The role of neovascularization in this field should be re-thought. Level of evidence V.

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Section: Diagnosismentioning

confidence: 99%

Neovascularization in Achilles tendinopathy: have we been chasing a red herring?

Tol

Spiezia

Maffulli

2012

Knee Surg Sports Traumatol Arthrosc

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“…Specifically, local tenderness of the Achilles 2-6 cm proximal to its insertion 71 • Decreased plantar flexor strength on affected side 69 • Decreased plantar flexor endurance, as demonstrated by a limited ability to perform repetitive unilateral heel raises, when compared to unaffected (or lesser affected) contralateral side 118 • Arc sign where the area of palpated swelling moves with dorsiflexion and plantar flexion 71 • Royal London Hospital test. This test is positive when tenderness occurs 3 cm proximal to the calcaneus with the ankle in slight plantar flexion, that decreases as the ankle is dorsiflexed 71 Self-reported localized pain and perceived stiffness in the Achilles tendon following a period of inactivity (ie, sleep, prolonged sitting), lessens with an acute bout of activity and may increase after the activity. Symptoms are frequently accompanied with Achilles tendon tenderness, a positive arc sign, and positive findings on the Royal London Hospital test.…”

Section: Diagnosis/classificationmentioning

confidence: 99%

Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis

Carcia

Martin²,

Houck³

et al. 2010

Journal of Orthopaedic & Sports Physical Therapy

118

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The Orthopaedic Section of the American Physical Therapy Association presents this sixth set of clinical practice guidelines on Achilles pain, stiffness, and muscle power deficits that are characteristic of Achilles Tendinitis. These clinical practice guidelines are linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) interventions provided by physical therapists, (3) and assessment of outcome for common musculoskeletal disorders. J Orthop Sports Phys Ther 2010:40(9):A1–A26. doi:10.2519/jospt.2010.0305

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“…Men and women, 20-60 years of age, with Achilles tendinopathy and duration of pain of more than 2 months were included. The definition of Achilles tendinopathy was the clinical diagnosis of a combination of Achilles tendon pain, swelling and impaired performance, as described in the literature (Kader et al, 2002, Paavola et al, 2002a, Maffulli et al, 2003a. The exclusion criteria were injury to foot, knee, hip or back and/or history of rheumatoid arthritis or any other illness or injury thought to interfere with participation in the study.…”

Section: Study IVmentioning

confidence: 99%

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Neeter

Thomeé

Silbernagel

et al. 2003

Scandinavian Med Sci Sports

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The purpose of this double‐blind study was to evaluate the effects of iontophoresis with dexamethazone to iontophoresis with saline solution on patients who had acute (less than 3 months) pain from the Achilles tendon, in terms of range of motion, muscular endurance, pain and symptoms. Twenty‐five patients (15 men and 10 women), aged between 18 and 76 years (mean = 38), were evaluated before and after 2 weeks of treatment with iontophoresis, as well as after 6 weeks, 3 and 6 months and 1 year. Two groups were treated for 2 weeks with iontophoresis for each treatment. Three ml of dexamethazone were used for the experiment group (n = 14) and 3 ml of saline solution for the control group (n = 11). Both groups then followed the same rehabilitation programme for 10 weeks. Good reliability was found for the toe‐raise and range of motion tests. Poor reliability was, however, found for the pain on palpation test, which was therefore excluded. No difference was found between or within groups for the toe‐raise test. Several significant improvements were seen in the experiment group but not in the control group, in the range of motion test, pain during and after physical activity, pain during walking and walking up and down stairs, morning stiffness and tendon swelling. Even though the small sample size limits the possibilities to draw definite conclusions, we conclude from the present study, using a double‐blind, randomised approach and a 1‐year follow‐up period, that positive effects from using iontophoresis with dexamethazone were found in the treatment of patients with acute Achilles tendon pain.

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Clinical Diagnosis of Achilles Tendinopathy With Tendinosis

Cited by 218 publications

References 19 publications

Neovascularization in Achilles tendinopathy: have we been chasing a red herring?

Neovascularization in Achilles tendinopathy: have we been chasing a red herring?

Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

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