9 1 General Introduction IMPACT Achilles tendinopathy is commonly seen in physically active individuals in middle age, with an incidence rate of 2-3 cases per 1,000 Dutch general practice registered patients.5-7 The incidence of Achilles tendinopathy has increased in the past decade, partly due to the growing number of people participating in physical activities.5,6 However, not all patients with Achilles tendinopathy are physically active and the increased prevalence of potential intrinsic risk factors as body weight or insulin resistance may also play a role in the increased incidence.5,6 Runners have a high risk of experiencing an Achilles tendon injury in their lifetime, with a cumulative incidence rate of 52%.8 The impact of this condition on patients is often measured using various outcome measures.9 These measures, such as pain intensity, functional limitations, and quality of life, provide valuable insights into the severity and progression of the condition. However, an important issue in research and in the field of Achilles tendinopathy specifically is the heterogeneity of the outcome measures used which limits comparability of study’s findings.9 The treatment of Achilles tendinopathy is often variable in clinical practice and more uniformity is necessary.6 Several treatment options for Achilles tendinopathy are available with conservative treatment being the primary approach.6,10 Calf muscle strengthening exercises are an important part of the treatment of Achilles tendinopathy as patients with Achilles tendinopathy have large deficits in plantar flexor strength and endurance.11,12 The single-leg heel rise endurance test (HRET) is a frequently used test to assess calf muscle strength endurance.12,13 A problem in the assessment of calf muscle strength and endurance is that the non-symptomatic limb cannot generally be used as reference and normative values for the HRET are currently lacking.11,14 Achilles tendinopathy can cause severe pain and reduced load-bearing capacity, resulting in a decreased quality of life.2,7,8 Qualitative research indicates that some patients with this condition experience a negative impact on their social activities, self-perceived fitness levels, and overall sense of identity.15-17 One exploratory study showed that individuals with Achilles tendinopathy have lower quality of life scores compared to normative data.16 Similarly, other musculoskeletal conditions can also impact quality of life, albeit to varying degrees.18-21 Understanding how Achilles tendinopathy affects quality of life can guide scientific research and help develop targeted management plans that address specific domains. There is currently limited knowledge regarding the impact of Achilles tendinopathy on work performance, healthcare utilization, and costs.
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