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Updated: Dec 16, 2025
Author Spotlight: Integrating Mechanical and Biological Analysis in Tendinopathy Research
Published on: March 1, 2024
How many runners with new-onset Achilles tendinopathy develop persisting symptoms? A large prospective cohort study
Iris F Lagas1, Tryntsje Fokkema2, Sita M A Bierma-Zeinstra1,2
1Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Zuid-Holland, The Netherlands.
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.
