Out of 10 clinical tests Where does it hurt?’ is a pain location question.  Such a question is one of the most reliable and accurate ‘tests’ for diagnosing Achilles tendinopathy.

In the not too distant past the Journal of Foot and Ankle Surgery published a scientific study entitled ‘What is the best clinical test for Achilles tendinopathy?’ The study by Hutchison and colleagues from the United Kingdom was published in 2013.

There is a long-standing rumor that published scientific knowledge requires 20 years to integrate into routine clinical practice. For this reason alone this post seemed necessary as Achilles tendinopathy is a very common problem facing athletes and non-athletes.

Self-reported pain location of Achilles tendinopathy

Research shows patient’s self-reported pain and palpation are valuable markers for diffierential diagnosis of Achilles tendinopathy

In 2011, de Jonge and colleagues (2011) estimated that 2 per 1,000 in the general population had what is known as mid-portion Achilles tendinopathy. This would equate to an annual incidence rate in Europe of approximately 4.5 million cases per year.  

Pain location provides insight for Achilles Tendinopathy

The authors  assessed the accuracy and validity of 10 clinical tests commonly employed by physiotherapists and general practitioners to reach a differential diagnosis of Achilles pathology.  Hutchison and colleagues (2013) found  subjective reports of pain and palpation were the most accurate and valid clinical tests.  Further, any combination of the 10 tests did not give a better prediction.  Thus no other clinical tests were recommended for use.

Everything should be made as simple as possible, but not simpler – Albert Einstein.

Navigate Pain Achilles tendinopathy pain drawing

Location of Achilles tendinopathy pain as drawn using the software Navigate Pain

A location element is present in about 90% of all pain complaints.  In this case, patients report pain 2-6 cm above the insertion of the Achilles tendon to the calceneum.  This means, to formulate clinical diagnosis of mid body Achilles tendinopathy the self-report of pain  can be used with a high positive predictive value.  Therefore, it is highly likely that a  ultrasound would only confirm the already achieved diagnosis.

Differential diagnosis can be facilitated by ultra-sound and magnetic resonance imaging (MRI).  So it seems costly and time-consuming procedures could be replaced with pain reports and palpation tests.

So the the next question is how much can Achilles tendinopathy pain differ between patients?  We are looking forward to hearing what our Navigate Pain users find out.


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Hutchison AM, Evans R, Bodger O, Pallister I, Topliss C, Williams P, Vannet N, Morris V, Beard D. What is the best clinical test for Achilles tendinopathy? Foot Ankle Surg. 2013 Jun;19(2):112-7. 

de Jonge Svan den Berg Cde Vos RJ, et al. Incidence of midportion Achilles tendinopathy in the general population