Achilles Tendinopathy Toolkit

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.

This article is currently under review and may not be up to date. Please come back soon to see the finished work! (9/05/2022)

Introduction

Translation of knowledge to practice in health care is a significant challenge. 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 Achilles Tendinopathy Toolkit is 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. It is an evidence based clinical decision making aid to assist clinicians in their management of achilles tendinopathy. Since the toolkit was developed it has been reviewed 90K times worldwide.

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. This KT initiative highlights the need for, challenges associated with, evidence-informed process for and positive response to the development of decision aids synthesizing the current evidence to guide clinical management of this patient population. With this in mind, in 2022 the toolkit, has been updated with the latest evidence, least accessed content deleted, new content added, and an engaging new look and feel!

The Achilles Tendionopathy Toolkit

The ‘Tendinopathy Toolkit’ includes:

• A tabulated summary of the evidence for manual therapy, exercise, low level laser therapy, ultrasound, extracorporeal shock wave therapy, iontophoresis using dexamethasone, taping, orthotics, night splints and braces, heel raise inserts, needling techniques, and the appropriate outcome measures for this population, targeted ‘take home messages’ and clinical implications are also included. The toolkit includes:
• The treatment algorithm section which will guide you through the subjective and physical assessment to confirm diagnosis of Achilles Tendinopathy
• Appendices including:
  • Section A - Clinical Evaluation
  • Section B - Outcome Measures
  • Section C - Summary of Evidence and Recommendations for Interventions
  • Section D - exercise programs
  • Section E - Low Level Laser Therapy Dosage Calculation
  • Section F - Medical and Surgical Interventions

Section A - Clinical Evaluation

This section 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.

Section B - Outcome Measures

This section presents patient-reported and performance-based outcome measures that are commonly reported in the literature, supported by expert opinion or often used clinically.

Section C - Summary of Evidence and Recommendations for Interventions

The purpose of this section is to provide physical therapists with a summary of the evidence and recommendations for interventions commonly used to manage mid‐substance Achilles tendinopathy. 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.

Section D - Exercise Programs

The exercise section will guide you through the rehabilitation stages for Achilles Tendinopathy describing the patient status at each phase, goals and suggested treatment program.

Section E - Low Level Laser Therapy Dosage Calculation

This section discusses the current recommendations and dosage calculation for prescribing low level laser therapy

Section F - Medical and Surgical Interventions

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 more strongly supported conservative management strategies (see “Section C - Summary of Evidence and Recommendations for Interventions”).