Achilles tendinopathy physical impairments evaluated through clinician-friendly measures: a systematic review with meta-analysis and GRADE recommendations

Background

Clinician-friendly tests, defined as affordable, portable, and readily available, can facilitate assessing and treating Achilles tendinopathy.

Objective

To identify physical impairments in individuals with Achilles tendinopathy using clinician-friendly tests.

Methods

Searches were performed in Medline, CINAHL, EMBASE, Web of Science, and Sportdiscus for studies comparing physical function between individuals with Achilles tendinopathy and controls using clinician-friendly measures. Study quality was assessed using the Downs and Black scale, and evidence certainty using GRADE approach. When possible, data were pooled through meta-analysis.

Results

Seventeen studies were included with 12 contributing to quantitative synthesis. Meta-analyses showed individuals with Achilles tendinopathy when compared with an asymptomatic group had: lower ankle dorsiflexion in a non-weight bearing position with knee bent (mean difference [MD] = 5.22, 95 % CI: 2.16, 8.28), lower ankle plantar flexion endurance on heel raises (MD = 10.47 repetitions, 95 % CI: 7.17, 13.76), and lower hip extension isometric strength (Effect Size= 0.49, 95 % CI: 0.12, 2.59). In those with Achilles tendinopathy, effect size analysis showed a greater Achilles tendon angle and tibia varus compared to an asymptomatic group, greater first ray and midfoot abduction laxity than the asymptomatic limb, and impaired jump performance compared to asymptomatic individuals and limb.

Conclusion

Low to moderate certainty evidence suggests those with Achilles tendinopathy have less ankle dorsiflexion, lower hip extension strength, lower ankle plantar flexion endurance, impaired hop performance, and greater Achilles tendon angle, tibia varus alignment, and first ray and midfoot abduction laxity. Clinicians should consider these impairments when assessing patients with Achilles tendinopathy.