Factors associated with midportion and insertional Achilles tendinopathy: a systematic review with meta-analysis and meta-regression.

Authors

Sven A Weerkamp, Marc A Paantjens, Faridi S van Etten-Jamaludin, Eric Wp Bakker

Published in

BMJ open sport & exercise medicine. Volume 12. Issue 4. Pages e003387. Epub Oct 27, 2026.

Abstract

To identify and evaluate factors associated with midportion Achilles tendinopathy (mid-AT) and insertional Achilles tendinopathy (ins-AT).
Systematic review with meta-analysis.
The databases MEDLINE Ovid, Embase, Web of Science, Cochrane Library and grey literature sources were searched up to 4 August 2025.
Cohort and case-control studies investigating factors associated with mid-AT and ins-AT separately were included.
19 primary studies (11 prospective cohort studies and 8 case-control studies) were included in this systematic review. For mid-AT, high-quality evidence was found for a previous episode of Achilles tendinopathy and very low-quality evidence for 17 other factors including: older age, adverse lipid profile, being registered as a marathon runner, decreased calf muscle strength, winter training, ultrasound parameters, decreased forward progression force during running and limited first metatarsophalangeal joint dorsiflexion. No associations were found between 48 other factors and mid-AT, including a previous running-related injury, body mass index and foot posture. For ins-AT, moderate-quality evidence was found for a previous episode of Achilles tendinopathy and very low-quality evidence for younger age as associated factors. No associations were found between 17 other factors and ins-AT, including Haglund's deformity and weight.
A wide range of non-modifiable, modifiable, imaging and biomechanical factors associated with mid-AT and ins-AT were identified, although most were supported by very low-quality evidence. High risk of bias and heterogeneity in the available evidence make the identification of factors associated with Achilles tendinopathy challenging.
CRD42024539362.

PMID:
42968923
Bibliographic data and abstract were imported from PubMed on 02 Nov 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.