Intrinsic risk factors for the development of achilles tendon overuse injury: a prospective study

Am J Sports Med. 2006 Feb;34(2):226-35. doi: 10.1177/0363546505279918. Epub 2005 Oct 31.


Background: Although Achilles tendon overuse injuries occur commonly, our understanding of the pathologic changes and the factors that predispose athletes to them is limited.

Purpose: To identify measurable intrinsic risk factors for Achilles tendon overuse injuries.

Study design: Cohort study (prognosis); Level of evidence, 2.

Methods: Sixty-nine male officer cadets followed the same 6-week basic military training. Before this training, each subject was evaluated for anthropometrical characteristics, isokinetic ankle muscle strength, ankle joint range of motion, Achilles tendon stiffness, explosive strength, and leisure and sports activity. During military training, Achilles tendon overuse injuries were registered and diagnosed by the same medical doctor. To identify the intrinsic risk factors, a multivariate analysis with the use of stepwise logistic regression was performed. The sensitivity, specificity, and cutoff values of the risk factors were evaluated by receiver operating characteristic curve analysis.

Results: Ten of the 69 male recruits (14.5%) sustained an Achilles tendon overuse injury diagnosed on the basis of medical history and clinical examination. Analysis revealed that male recruits with lower plantar flexor strength and increased dorsiflexion excursion were at a greater risk of Achilles tendon overuse injury. The cutoff value of the plantar flexor strength at 85% sensitivity was 50.0 N.m, with a 4.5% specificity; the cutoff value of the dorsiflexion range of motion at 85% sensitivity was 9.0 degrees , with 24.2% specificity.

Conclusions: The strength of the plantar flexors and amount of dorsiflexion excursion were identified as significant predictors of an Achilles tendon overuse injury. A plantar flexor strength lower than 50.0 N.m and dorsiflexion range of motion higher than 9.0 degrees were possible thresholds for developing an Achilles tendon overuse injury.

MeSH terms

  • Achilles Tendon / injuries*
  • Adolescent
  • Adult
  • Belgium
  • Cumulative Trauma Disorders / etiology*
  • Humans
  • Leg
  • Logistic Models
  • Male
  • Military Personnel
  • Multivariate Analysis
  • Muscle, Skeletal / physiology*
  • Prospective Studies
  • ROC Curve
  • Range of Motion, Articular
  • Risk Factors
  • Sensitivity and Specificity
  • Surveys and Questionnaires