Hindfoot endoscopy.

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Abstract

[Indexed for MEDLINE] 8. Br J Sports Med. 2025 Jun 18;59(13):891-901. doi: 10.1136/bjsports-2024-109185. Diagnostic domains, differential diagnosis and conditions requiring further medical attention that are considered important in the assessment for Achilles tendinopathy: a Delphi consensus study. Malliaras P(1), Gravare Silbernagel K(2), de Vos RJ(3), Bourke J(4), Sancho I(5), Hanlon SL(6), Agergaard AS(7), Bahr R(8), Bittencourt NFN(9)(10), Bordalo M(11), Brorsson A(12), Tzortziou Brown V(13), Cardoso T(14), Child S(15), Chimenti RL(16), Cowley E(17), D'Hooghe P(18), Derman W(19), Finnoff JT(20)(21), Fu SN(22), Halstead J(23)(24), Hamilton B(25), Nilsson-Helander KM(26), Hölmich P(27), Houghton J(28), James AM(29), Kulig K(30), Lau A(31), Ling S(32), Maffulli N(33)(34), Masci L(31), Mayes S(35), Mc Auliffe S(36), McCrum C(37), Morrissey D(38)(39), Munteanu SE(40), Murphy MC(41)(42), Newsham-West R(35), O'Neill S(43), Padhiar N(44), Papadopoulou T(45), Rees JD(28), Rio EK(46), Ruffino D(47), Scott A(48), Speirs S(49), Sun Y(50), Thorborg K(51), Trease L(35), Verhaar JAN(52), Wezenbeek E(53), White S(54), Zellers JA(55), Zhang S(56), Korakakis V(57), Vicenzino B(58). Author information: (1)Physiotherapy Department, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia peter.malliaras@monash.edu. (2)Department of Physical Therapy, University of Delaware, Newark, Delaware, USA. (3)Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Netherlands. (4)Physiotherapy Department, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia. (5)Deusto Physical TherapIker Group, Physical Therapy Department, University of Deusto Faculty of Health Sciences, Donostia - San Sebastian, Spain. (6)Department of Kinesiology, California State University Fullerton, Fullerton, California, USA. (7)Department of Orthopedic Surgery, and Department of Physical and Occupational Therapy, Copenhagen University Hospital-Bispebjerg and Frederiksberg Institute of Sports Medicine Copenhagen, Copenhagen, Denmark. (8)Norwegian School of Sport Sciences, Oslo Sports Trauma Research Center, Oslo, Oslo, Norway. (9)Esporte Clube Bahia, Salvador, Brazil. (10)Soccer Science Center, Federal University of Minas Gerais, Belo Horizonte, Brazil. (11)Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar. (12)Department of Orthopaedics, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden. (13)Queen Mary University of London Wolfson Institute of Population Health, London, UK. (14)Alphington Sports Medicine, Northcote, Victoria, Australia. (15)Olympic Park Sports Medicine Centre, Melbourne, Victoria, Australia. (16)Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA. (17)University of Southampton School of Health Sciences, Southampton, UK. (18)Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar. (19)Institute of Sport and Exercise Medicine (ISEM), Department of Exercise, Sport and Lifestyle Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Tygerberg, South Africa. (20)United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA. (21)Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, Colorado, USA. (22)Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong. (23)Leeds Community Healthcare NHS Trust, Leeds, UK. (24)University of Leeds Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, West Yorkshire, UK. (25)High Performance Sport New Zealand, Auckland University of Technology, Auckland, New Zealand. (26)Department of Orthopaedics, Sahlgrenska University Hospital Mölndal, Institute of Clinical Science at Sahlgrenska Academy, Goteborg, Sweden. (27)Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark, Hvidovre Hospital Department of Orthopaedic Surgery, Hvidovre, Denmark. (28)Fortius Clinic, London, UK. (29)Podiatry, Peninsula Health, Frankston, Victoria, Australia. (30)Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA. (31)Institute of Sport Exercise and Health, London, UK. (32)Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong. (33)Department of Trauma and Orthopaedic Surgery, University of Rome La Sapienza Faculty of Medicine and Psychology, Roma, Italy. (34)Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, London, UK. (35)La Trobe University La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia. (36)Department of Physiotherapy, University of Limerick, Limerick, Ireland. (37)Rheumatology Department, Canberra Health Services, Canberra, Australian Capital Territory, Australia. (38)Sport and Exercise Medicine, Queen Mary University of London, London, UK. (39)Physiotherapy Department, Barts Health NHS Trust, London, UK. (40)Discipline of Podiatry, La Trobe University School of Allied Health, Human Services, and Sport, Melbourne, Victoria, Australia. (41)Nutrition and Health Innovation Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia. (42)School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia. (43)School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK. (44)Barts and The London School of Medicine and Dentistry, London, UK. (45)Stanford Hall Defence Medical Rehabilitation Centre, Loughborough, UK. (46)La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia. (47)Universidad Nacional de Córdoba, Cordoba, Argentina. (48)Physical therapy, The University of British Columbia - Vancouver Campus, Vancouver, British Columbia, Canada. (49)One Welbeck Surgery Centre, London, UK. (50)Huashan Hospital Fudan University Department of Sports Medicine, Shanghai, China. (51)Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark, Hvidovre Hospital, Hvidovre, Denmark. (52)Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, Netherlands. (53)Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerpen, Belgium. (54)Victorian Institute of Sport, Albert Park, Victoria, Australia. (55)Program in Physical Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri, USA. (56)Sports Medicine, Fudan University, Shanghai, Shanghai, China. (57)Department of Health Sciences, University of Nicosia, Nicosia, Nicosia, Cyprus. (58)Physiotherapy, The University of Queensland, Brisbane, Queensland, Australia. The absence of agreed methods to diagnose Achilles tendinopathy impedes research and clinical practice. This gap results in heterogeneous and/or poorly described study samples, making it challenging to apply findings in clinical practice. The aim of this Delphi study was to define consensus on (1) diagnostic domains; (2) differential diagnoses; and (3) conditions requiring further medical attention, when assessing for Achilles tendinopathy.We conducted a sequential three-stage process which included: (1) identifying diagnostic domains, differential diagnoses and conditions requiring further medical attention based on existing scoping reviews and clinical practice guidelines; (2) developing Delphi survey questions; and (3) administering a five-round Delphi online survey. Consensus was defined as ≥70% agreement.52 participants completed the surveys. Four diagnostic domains were deemed essential and reached consensus (pain location (93%); pain during activity (97%); tests that provoke pain (87%); palpation to assess pain (83%)). 15 differential diagnoses reached consensus: 2 for both midportion and insertional (partial tear (80%); posterior ankle impingement (78%)), 6 for midportion (plantaris tendinopathy (84%); tibialis posterior or flexor hallucis longus tendinopathy/tenosynovitis (72%); flexor digitorum longus tendinopathy (77%); accessory soleus muscle (74%); paratendinopathy (86%); sural nerve neuropathy (81%)) and 7 for insertional (superficial (88%) and retrocalcaneal bursitis (86%); Haglund's/calcaneal exostosis (80%), intratendinous calcifications (73%); Sever's disease (78%); calcaneal stress reaction/fracture (80%); subtalar/ankle pain (71%)). Six conditions requiring further medical attention reached consensus: (Achilles tendon rupture (83%); systemic inflammatory joint disease (86%); metabolic syndrome (75%); familial hypercholesterolaemia (77%); endocrine and hormonal disorders (80%); drug reactions (77%)).This consensus identified essential diagnostic domains, differential diagnoses and conditions requiring further medical attention that should be considered when assessing for Achilles tendinopathy. © Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group. DOI: 10.1136/bjsports-2024-109185