How many runners with new‐onset Achilles tendinopathy develop persisting symptoms? A large prospective cohort study

BACKGROUND: Achilles tendinopathy (AT) occurs in half of the elite runners. AT is a difficult‐to‐treat tendon disease, which may progress from new onset to a chronic state. It is unknown how many runners with new‐onset AT develop persisting symptoms and which prognostic factors are associated with this course. OBJECTIVE: To describe how many runners develop persisting symptoms 1 year after onset of reactive AT. STUDY DESIGN: Prospective cohort study. METHODS: Runners registering for a Dutch running event (5‐42.2 km) were eligible for inclusion. Runners reporting new‐onset AT between registration for the running event and 1 month after received a 1‐year follow‐up questionnaire. The 1‐year follow‐up questionnaire inquired about persisting symptoms (yes/no), running activity, and metabolic disorders. We calculated the percentage of runners with persisting symptoms and performed a multivariable logistic regression analysis to study the association between potential prognostic factors and persisting symptoms. RESULTS: Of 1929 participants, 100 runners (5%) reported new‐onset AT. A total of 62 runners (62%) filled in the 1‐year follow‐up questionnaire. Persisting symptoms were reported by 20 runners (32%). A higher running distance per week before new‐onset AT was associated with a lower risk of developing persisting symptoms (odds ratio (OR): 0.9, 95% confidence interval (CI): [0.9;1.0]). There was a positive trend toward an association between metabolic disorders and persisting symptoms (OR: 5.7, 95% CI: [0.9;36.2]). CONCLUSION: One third of runners develop persisting symptoms 1 year after new‐onset AT. Interestingly, a higher running distance per week before new‐onset AT potentially lowers the risk of developing persisting symptoms.