Table 4

Potential risk factors investigated in the 10 cohort studies as potential risk factor for Achilles tendinopathy

Potential risk factorsStudy (first author and reference number)Best evidence synthesis
Patient characteristics (non-modifiable)
AgeBarge-Caballero =24, Owens birth year >1980 ↓,17 Van Ginckel =19 Conflicting evidence
SexBarge-Caballero =24, Owens =17 Wezenbeek female ↑23 Conflicting evidence
EthnicityOwens =17 Limited evidence for no association
HeightMahieu =,16 Milgrom =,22 Van Ginckel =,19 Wezenbeek ↑23 Limited evidence for no association
Prior lower limb tendinopathy or fractureOwens ↑17 Limited evidence for positive association
Patient characteristics (modifiable)
Body mass indexOwens BMI >25.0 ↑,17 Mahieu =,16 Milgrom =,22 Rabin =,18 Van Ginckel =,19 Wezenbeek =23 Limited evidence for no association
Body weightMahieu =,18 Milgrom =,22 Van Ginckel =,23 Wezenbeek ↑23 Limited evidence for no association
Alcohol useOwens 7–13 units per week for men, 4–6 units per week for women ↑,17 Owens 14+ units per week for men, 7+ units per week for women =17 Limited evidence for positive association (moderate alcohol use)
SmokingOwens =17 Limited evidence for no association
Physical activity level and performanceMahieu physical activity level =,16 Van Ginckel physical activity level=,19 Milgrom physical activity performance (2 km run and maximum number of chin-ups and sit-ups) =,22 Wezenbeek =23 Limited evidence for no association
Biomechanical factors
Shoe typeMilgrom =22 Limited evidence for no association
Leg dominanceWezenbeek =23 Limited evidence for no association
Limited non-weight-bearing ankle dorsiflexion with knee extendedKaufman <11.5° ↑,21 Mahieu =16 Conflicting evidence
Increased non-weight-bearing ankle dorsiflexion with the knee bentMahieu =,16 Rabin ↓,18 Kaufman =21 Conflicting evidence
Hindfoot inversionKaufman =21 Limited evidence for no association
Hindfoot eversionKaufman =21 Limited evidence for no association
Static arch index of the footKaufman =,21 Milgrom =22 Limited evidence for no association
Dynamic arch index of the footKaufman =21 Limited evidence for no association
Pronated foot postureWezenbeek =23 Limited evidence for no association
Increase in isokinetic plantar flexor strength at 30° (low velocity)Mahieu ↓16 Limited evidence for protective association
Explosive gastrocnemius-soleus muscle strengthMahieu =16 Limited evidence for no association
External rotation of the hipMilgrom =22 Limited evidence for no association
Tibial intercondylar distanceMilgrom =22 Limited evidence for no association
lower extremity quality of movement testRabin =18 Limited evidence for no association
Increased total displacement of the Y-component of the centre of the centre of forceVan Ginckel ↓19 Limited evidence for protective association
Increased medial directed force distributionVan Ginckel ↓19 Limited evidence for protective association
Pre-existing diseases
Renal dysfunction (creatinine clearance <60 mL/min)Barge-Caballero ↑24 Limited evidence for positive association
increased time between heart transplantation and initiation of quinolone treatment for infectious diseaseBarge-Caballero ↑24 Limited evidence for positive association
Medication
Fluoroquinolones as groupVan der Linden =25 Limited evidence for no association
LevofloxacinBarge-Caballero =24 Limited evidence for no association
OfloxacinVan der Linden ↑25 Limited evidence for positive association
CiprofloxacinVan der Linden =25 Limited evidence for no association
NorfloxacinVan der Linden =25 Limited evidence for no association
Daily prednisone doseBarge-Caballero =24 Limited evidence for no association
Training factors
Training in the winter seasonMilgrom ↑22 Limited evidence for positive association
  • Associations found in this systematic review are marked with the grey columns.

  • =no association; ↑ positive association; ↓protective association.