Ankle & Foot Assessment

Royal London Hospital Test | Achilles tendinopathy / tendinitis

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Royal London Hospital Test

Royal London Hospital Test | Achilles tendinopathy/tendinitis

Achilles Tendinopathy is a common injury seen in sporting populations. Traditionally, the diagnosis of Achilles tendinopathy is based on clinical presentation and history taking revealing Achilles tendon pain that’s usually worse in the morning and that warms up during activity. Often, patients report a sudden spike in activity that overloaded the tendon. Reiman et al (2014) reviewed the literature on tests for Achilles tendon pathology and found a pooled sensitivity of 54% and a specificity of 86% for the Royal London Hospital Test. As the included studies were of mixed risk of bias and on the basis of the found values the clinical value is at most moderate.

To conduct the test, the patient can be in sitting position with the foot over the edge of the bench. The ankle is in neutral or slight plantarflexed position while you palpate the achilles tendon for tenderness. In midportion tendinopathy, this is commonly the case 2-5cm from the calcaneal insertion or right at the calcaneus in insertional tendinopathy.
The patient is then asked to move the ankle into maximum dorsiflexion. The tendon is then again palpated at the previously found tender spot.
Then the patient moves the foot into maximum plantarflexion and the tender spot is again palpated.

The test is considered positive for achilles tendinopathy if the pain on the tender spot initially found is absent in the maximally dorsiflexed position.
The authors have no explanation as to why the pain disappears on maximal tension on the tendon.

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Another orthopedic test for Achilles tendinopathy is the Arc Test that can help to distinguish between Achilles tendinopathy and an inflammation of the tendon sheath, called tenosynovitis.

 

References

Reiman, M., Burgi, C., Strube, E., Prue, K., Ray, K., Elliott, A., & Goode, A. (2014). The utility of clinical measures for the diagnosis of Achilles tendon injuries: a systematic review with meta-analysis. Journal of athletic training, 49(6), 820-829.

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