Table 13. A method for clinically diagnosing Achilles tendinopathy.

Test	Definition of test	Feature	Core health domain
Subjective history
Self-reported location of pain	Clinician asks patient “Can you point out where you get your pain”	Pain located 2–6 cm above the calcaneal insertion (midportion) Pain located in the distal 2 cm of the Achilles tendon	N/A
Self-reported pain with tendon loading	Patient reported intensity of pain using a VAS or NPRS while performing an Achilles tendon-specific loading task (single-leg heel raise, hopping)	Patient reported increased pain on a VAS or NPRS with Achilles tendon-specific loading task (single-leg heel raise and hopping)	Pain with loading or activity
Self-reported tendon stiffness or pain over a specified time	Clinician asks about pain and stiffness over specified timeframes (e.g. morning, night, 24 hours)	Patient reported morning stiffness or pain Patient reported pain or stiffness at the onset of activity that may “warm-up”	Pain over a specified time
Self-reported overall rating of Achilles tendon	Clinician asks “Can you rate your Achilles tendon where 100% represents no problems and 0% is the worst-case scenario”	Patient reported level of condition	Patient rating of overall condition
Objective tests
Palpation	Performed by the clinician gently palpating the whole length of the tendon in a proximal to distal direction	Patient reported pain located 2–6 cm above the calcaneal insertion (midportion) with or without subjective opinion of tendon thickening or swelling Patient reported pain located in the distal 2 cm of the Achilles tendon with or without subjective opinion of tendon thickening or swelling	N/A
Single-leg heel raise	Performed by patient rising up on to tip toes and lowering back down in a controlled manner, on both the affected and non-affected leg	Clinician recorded number of completed single-leg heel raises on each leg	Physical function capacity
Hopping	Performed by participant hopping on the spot	Clinician recorded number of completed hops on each leg	Physical function capacity
The Royal London Hospital Test	Performed by the clinician palpating the tendon for any local tenderness with the ankle either in neutral position or in slight plantarflexion. The ankle is then actively dorsiflexed and plantarflexed. With the ankle in maximum dorsiflexion, the portion of the tendon found to be tender is palpated again.	Patient reported pain on palpation reduces significantly or disappears with maximum dorsiflexion	N/A
Painful Arc Sign	Performed by the clinician identifying the intratendinous swelling in the tendon and asking the patient to actively dorsiflex and plantarflex the ankle joint observing the movement of the swelling between the malleoli	The intratendinous swelling moves relative to the malleoli with the Achilles tendon during the ankle movement	N/A
Outcome measures
VISA-A	The VISA-A questionnaire is a valid and reliable tool to evaluate clinical severity of Achilles tendinopathy that has been translated into multiple languages. Patients can self-administer the questionnaire	The maximum score is 100, with healthy subjects scoring a minimum of 96 (Malliaras et al., 2015).	Disability
PCS	Patients are asked to indicate the degree to which they have the above thoughts and feelings when they are experiencing pain using the 0 (not at all) to 4 (all the time) scale.	A total score is yielded (ranging from 0-52), with a score of 30 or below indicating a clinically relevant level of catastrophising (Scott et al., 2013).	Psychological factors
SF-12	The SF-12 is a self-reported outcome measure assessing the impact of health on an individual’s everyday life.	The SF-12 creates two summary scores, mental health and physical health (Pham et al., 2014).	Quality of Life

Note:

N/A, not applicable; cm, centimetres; VAS, Visual Analogue Scale; NPRS, Numerical Pain Rating Scale; VISA-A, Victorian Institute of Sport Assessment-Achilles; PCS, Pain Catastrophising Scale; SF-12, 12-Item Short Form Survey.