9 167 General discussion FUTURE RESEARCH This thesis has shed new light on the management of Achilles tendinopathy and has added to the accumulating knowledge regarding the impact, diagnostic imaging and prognosis of this condition. However, new questions have emerged ad several remain unanswered. We recommend future research to focus on answering the following questions: 1. What are the normative values of radiologic diagnostic criteria such as tendon structure, Doppler flow and intratendinous calcifications on imaging when evaluated in a large group of asymptomatic individuals and compared with Achilles tendinopathy patients? 2. Does the use of imaging in patient education improve treatment adherence or response to treatment? 3. What are the underlying mechanisms responsible for worse treatment outcomes among tendinopathy patients belonging to lower SES groups? The approach to answer these research questions will depend on the type of the question. Some of these questions can only be answered when large amounts of participants will be included in new study projects. In numerous medical domains, ‘Big Data’ has emerged as a potential solution for addressing research questions. Examples are the Scandinavian Anterior Cruciate Ligament registry and the Dutch Arthroplasty Registry. In the field of tendinopathy this approach has not been used before. We propose the establishment of large (inter)national databases/registries for patients with Achilles tendinopathy. This initiative aims to advance our understanding of this debilitating condition and, ultimately, to prevent that future individuals being ´struck´ with Achilles tendinopathy will not experience a downfall as did the legendary warrior Achilles.
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