PhD Defense: Improving clinical evaluation and decision-making in military personnel with mid-portion Achilles tendinopathy.

Despite treatment, military personnel with Achilles tendon symptoms often struggle with long lasting pain. Symptoms can also recur. This sometimes prohibits individuals from work or exercise for a long time. The studies were conducted to better help military personnel with Achilles tendon symptoms.

In patients with symptoms, degenerative Achilles tendon changes are often encountered. We assumed that information about tendon quality could improve treatment. First, we examined the reliability of conventional ultrasound. Although this proved to be very reliable, we switched to ultrasound tissue characterization (UTC). This advanced ultrasound technique can distinguish 'degenerative tendon fibers' from 'normal tendon fibers'. UTC is reliable, but the UTC scores correspond poorly with symptoms as measured with the 'VISA-A questionnaire'. However, personnel with more degenerative changes had a greater chance of a recurrence. We still have to investigate whether we can reduce the number of recurrences with this finding.

Shockwave treatment is used to treat Achilles tendon symptoms. Treatment can be painful and there were doubts about its effectiveness. Should we continue to use shockwave? Our literature review showed that shockwave is effective when used additional to standard treatment for symptoms in the middle part of the tendon, but not at the attachment.

To better understand symptoms of military personnel, we determined military-specific thresholds on the VISA-A questionnaire. We found that improvementscores of 7 points or more (range 0=poor – 100=good) indicate that an individual actually experiences fewer symptoms. With a score of 96 points or more, a full return to activities may be advised.