5 89 Standardized Pain Mapping for Diagnosing Achilles Tendinopathy Institute of Sports Assessment-Achilles (VISA-A) questionnaire was also completed. This questionnaire evaluates pain score and activity level and ranges from 0 to 100 (with lower scores corresponding with more pain and decreased activity).17 Figure 1. The standardized pain map included in the baseline questionnaire. The standardized pain map in the way it was provided to the patients. Descriptions in laymen terms in the way it was provided to the patients. A = bottom of the heel (attachment plantar tendon to the heel bone), B = back of the heel (attachment of the Achilles tendon to the heel bone), C = middle part of the Achilles tendon (2-7 cm above the attachment of the Achilles tendon to the heel bone). Patients indicating their symptoms to entail region A were excluded from the analysis as the pain was not located to the Achilles tendon region. All patients then had a complete history-taking and clinical examination by a single senior sports medicine physician (Details omitted for review). The outpatient appointment was scheduled between one and maximal 7 days after the completion of the digital questionnaire. A study flow chart is presented in Figure 2. History-taking included whether patient’s symptoms were associated with (sports) activities. Physical examination included assessing tendon thickening and pain on tendon palpation. Palpation of the tendon was performed by gently squeezing the Achilles tendon between the index finger and thumb, hereby palpating the entire length of the tendon from the musculotendinous junction to the distal calcaneal insertion. Patients were asked whether they experienced recognizable pain on palpation.18 The location (midportion/insertion) of recognizable pain was recorded by the clinician. Presence of tendon thickening was assessed by the clinician on palpation.6 Based on patient history and physical examination, a clinical diagnosis was made.
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