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