Achilles Tendinopathy Toolkit

Original Editor - Kim Jackson for The BC Physical Therapy Tendinopathy Task Force:

Prof. Alex Scott, Dr Joseph Anthony, Dr Allison Ezzat, Prof Angie Fearon, JR Justesen, Dr Allison Ezzat, Dr Angie Fearon, Carol Kennedy, Michael Yates, Paul Blazey and Alison Hoens.

Top Contributors - Kim Jackson, Lucy Aird, Admin, Olajumoke Ogunleye, Scott Buxton, Simisola Ajeyalemi, Wanda van Niekerk and Rucha Gadgil

Introduction

Translation of knowledge to practice in health care is a significant challenge. Clinicians want to provide evidence-informed management of tendinopathy but many struggle with accessing, appraising and synthesizing the vast array of literature available on this topic. As a result a project was undertaken by a unique partnership of physical therapy researchers, educators and expert clinicians to address the gap between evidence and practice in the management of Achilles Tendinopathy. The original toolkit was produced in April 2012, and since its release it has been viewed more than 90,000 times worldwide.

To keep the toolkit contemporary, a BC (British Columbia) Physical Therapy Knowledge-Broker facilitated project team reviewed and re-released an updated version of the Achilles Tendinopathy toolkit in 2022. The 2022 update includes the latest evidence, new sections to support clinical decision-making, and an engaging new look and feel! What follows is a modified version of the toolkit for Physiopedia produced in collaboration with the authorship team.

The Achilles Tendinopathy Toolkit

This decision‐making tool is evidence‐informed and where there is insufficient evidence, expert‐informed. It is not intended to replace the clinician’s clinical reasoning skills and inter‐professional collaboration. ‘Acute’ refers primarily to the stage with the cardinal signs of heat, redness, pain, swelling and loss of function and a very recent onset of symptoms.

The following algorithm, taken from the toolkit, suggests the steps to follow to help guide the treatment and improve outcomes of a patient presenting with Achilles pain:

The other sections provide physical therapists with summary of the evidence and recommendations for interventions (Section C) commonly used to manage mid‐substance Achilles tendinopathy, as well as insights into:

• Clinical Evaluation - Section A of the toolkit discusses the clinical evaluation of somebody who has been diagnosed with Achilles Tendinopathy - identifies the potential risk factors association with Mid-Portion Achilles Tendinopathy, the subjective and objective assessment, Functional Tests and Differential Diagnosis.
• Outcome Measures - Section B presents patient-reported and performance-based outcome measures that are commonly reported in the literature, supported by expert opinion or often used clinically.
• Summary of Evidence and Recommendations for Interventions - Section C provides a summary of the evidence and recommendations for interventions
• Exercise Programs - Section D will guide you through the rehabilitation stages for Achilles Tendinopathy describing the patient status at each phase, goals and suggested treatment program.
• Low Level Laser Therapy Dosage Calculation - Section E discusses the current recommendations and dosage calculation for prescribing low level laser therapy.
• Medical and Surgical Interventions -Section F the purpose of this section is to summarize common medical and surgical interventions which may be considered for the management of Achilles tendinopathy – particularly if it is not responding adequately to recommended conservative management strategies (see “Section C - Summary of Evidence and Recommendations for Interventions”).

Resources

• UBC Achilles Tendinopathy Toolkit