5 93 Standardized Pain Mapping for Diagnosing Achilles Tendinopathy Primary outcome – Agreement of pain mapping with the clinical diagnosis of Achilles tendinopathy The main clinical diagnostic criteria were present in the majority of the patients. The presence of pain associated with tendon-loading activities (100%) and recognizable pain on tendon palpation (95%) were very frequent, while the presence of localized tendon thickening had a lower frequency (70%). In 102 (93%) of the patients who indicated pain in the Achilles tendon region on the standardized pain map, the clinical diagnosis of Achilles tendinopathy was made (Kappa = 0.86, 95% CI 0.78-0.95) . In 6 (5%) patients another diagnosis was established, as there were none or 1 criteria present for the clinical diagnosis of Achilles tendinopathy (4 patients) or there were 2 criteria for Achilles tendinopathy but the clinical picture was more consistent with another diagnosis (2 patients). The list of these other diagnoses is provided in Table 2. Two patients (2%) did not fulfil the predefined criteria for the clinical diagnosis of Achilles tendinopathy. One only had localized activity-related pain and the other one had localized activity-related pain and Achilles tendon thickening. These patients were not diagnosed with Achilles tendinopathy. Table 2. List of other diagnoses Number of patients None or only 1 criteria present for the clinical diagnosis of Achilles Soleus muscle strain 2 Posterior ankle impingement 1 2 criteria for Achilles tendinopathy but the clinical picture was more consistent with another diagnosis Retrocalcaneal bursitis without Achilles tendon pathology 1 Achilles midportion paratendinopathy 1 Neglected full-thickness Achilles tendon rupture 1
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