Diagnosis of the Achilles Insertional Tendinopathies by Algometry

CATEGORY: Ankle; Hindfoot INTRODUCTION/PURPOSE: Diagnosis of Achilles insertional tendinopathies (AIT) is based on pain by tendon palpation. However, there is no consensus or standard regarding the amount of force to be used during the evaluation. The algometry is a method of measuring the pressure applied in a specific region and can be a method for determining diagnosis values. Goal: To determine a cut-off value for Pain Threshold (PT) in the assessment of AIT. METHODS: Design: This is a prospective case-control study of diagnostic accuracy, to develop a diagnostic criterion. Methods: Forty asymptomatic individuals and forty patients with insertional Achilles tendinopathy, matched by age and sex, were evaluated, and submitted to algometry for PT and for Visual Analogical Scale (VAS) levels with 3kg/f at the insertion of the calcaneal tendon by two different evaluators. Inter-observer reproducibility was accessed through the interclass correlation index (ICC). Sensitivity and specificity calculation of PT and of VAS were calculated and plotted on a ROC (Receiver Operator Characteristic) curve. RESULTS: The lowest ICC found was 0.788. Regarding the diagnosis through TP, the 4.08 kg/f mark showed the best relation between sensitivity and specificity (92.5% and 92.5%, respectively). Algometry values lower than 4.08 were considered positive for disease. For the diagnosis of TIA through VAS with 3kg/f, the value of 2.98 was determined (sensitivity of 92.5% and specificity of 97.5%). CONCLUSION: This study showed that algometry is a reliable method in the assessment of Achilles insertional tendinopathies, having a high intra-observer reproducibility. The painful threshold for establishing the diagnosis of Achilles insertional tendinopathies was 4.08 kg/, with values below this number considered altered.