5 87 Standardized Pain Mapping for Diagnosing Achilles Tendinopathy INTRODUCTION Achilles tendinopathy is a tendon disorder with a substantial socio-economic impact and is characterized by persistent localized Achilles tendon pain related to mechanical loading.1,2 It can affect both the insertional and midportion (2-7 cm proximal of the calcaneal insertion) region of the tendon.3 Achilles tendinopathy is mainly a clinical diagnosis, with imaging being a supportive method. 4,5 The most frequently used diagnostic criteria of Achilles tendinopathy are localized Achilles tendon pain associated with tendon-loading activities, pain on Achilles tendon palpation and localized tendon thickening.4 These three findings can be assessed reliably.6 Experts agree that the clinical diagnosis can be established when there is localized pain associated with tendon-loading activities and pain on Achilles tendon palpation, as the presence of tendon thickening is not always necessary to make the clinical diagnosis.4,5 While there remain challenges in the diagnosing of Achilles tendinopathy, there is agreement among experts about the above-mentioned criteria.4,5,7 The location of pain is a key diagnostic criterion and it is important to distinguish between the insertional and midportion region of the Achilles tendon. This location affects prognosis and initial treatment.6,8 Because the clinical sign of subjective self-reported pain is one of the criteria for establishing the diagnosis it is important to know if patients with pain in the Achilles region can adequately localize their pain.5 Pain mapping is a tool for patients to indicate the location where they experience most of their pain and could assist in the diagnosis of musculoskeletal conditions.9-12 Researchers previously suggested a self-administered pain map to be a useful and effective way to diagnose patients with patellar tendinopathy in a large group of subjects.13 Knowing the reliability of using a self-administered standardized pain map for diagnosing Achilles tendinopathy could help clinicians with adequate triage. Additionally, in the near future it could be very helpful using digital support in first line care for the effective implementation of targeted treatment advices and in large epidemiological studies. The level of agreement between patient-reported pain using a pain map and the physician-determined clinical diagnosis of Achilles tendinopathy is currently unknown. The primary objective of this study was to assess the level of agreement between patientreported pain on a standardized pain map with the physician-determined clinical diagnosis of Achilles tendinopathy (defined as localized pain associated with tendon-loading activities and pain on palpation with or without tendon thickening). The secondary objective was to assess the level of agreement between the patient-reported location (midportion or insertional region) of the pain, marked on the standardized pain map with the physiciandetermined clinical diagnosis of midportion or insertional Achilles tendinopathy.
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